Laserfiche WebLink
SAN JOAQUIN COUNTY � <br /> A.) <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> j (209)468-3420•Fax.,(209)464-3433• Web:www.siciov.ora/ehd <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> A. EMERGENCY LEVEL 01 ❑u ❑ III JEHDLOG# <br /> B. SOURCE OF INFORMATION <br /> NAME: L6-.'j PHONE <br /> COMPANY: E�Ttf> CITY: <br /> ADDRESS: fVyy 0061- <br /> unia a Naidu P- 209 8.,°439 <br /> DESIGNATED EMPLOYEE NAME PP HONE: ( )46 <br /> REPORTING AGENCY NAME:. San Joaquin County Environmental Health Department <br /> ADDRESS: 1868 E. Hazelton Ave.,Stockton, CA 95205-8232 <br /> C. LOCATION AND DATE OF DISCHARGE <br /> LOCATION: /1 �� Q'�- % Incorporated <br /> Best Physical `6-7cl t.4 wN' �� "� CITY g <br /> Desai tion 1 1 ❑ Unincorporated <br /> DATE OF DISCHARGE: <br /> DATE NOTIFIED: t L ( TIME: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> NAME OF BUSINESS: <br /> CONTACT PERSON: PHON <br /> PHYSICAL ADDRESS: <br /> MAILING ADDRESS'. <br /> E. DESCRIPTION <br /> TYPE OF DISCHARGE <br /> VOLUME Q O <br /> CHEMICALS: <br /> CIRCUMSTANCES: A 1 -� "CVtent- <br /> F. ACTION TAKEN <br /> SITE DISPOSITION <br /> �-�4�t,B2erf i�L[-cam -�iv� �e.yjl.ca-�-eB� <br /> Revised 0e1D2112 d Page 1 of 2 NOTIFICATION OF HAZ WASTE DISCHARGE <br />