Laserfiche WebLink
SAN JOAQUIN COUNTY O s <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br />{' V IN ..I . t 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> (209)468-3420- Fax: (209)464-3433 • Web:www.s' ov,ar /ehd <br /> I I <br /> f NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> A. EMERGENCY LEVEL ❑x l [] II [] ul EHD LOG# <br /> B. SOURCE OF INFORMATION <br /> NAME: PHONE: (eII lam) C)rl4-4 <br /> COMPANY: DAE&VEi <br /> 0 ` l� s� <br /> 1�-c, rrCc+� CITY: <br /> ADDRESS: <br /> DESIGNATED EMPLOYEE NAME: Muniappa Naidu PHONE: (209)468-3439 <br /> REPORTING AGENCY NAME: San JOagUin County Environmental Health Department <br /> ADDRESS: 1868 E. Hazelton Ave„ Stockton, CA 95205-6232 <br /> C. LOCATION AND DATE OF DISCHARGE <br /> LOCATION: <br /> Best Physical <br /> incorporated <br /> Descri tion � �''� '`rte CITY 5 v��u-� <br /> Unincorporated <br /> DATE OF DISCHARGE: r� Zib 3 <br /> DATE NOTIFIED: (e j TIME. 4- <br /> -D. <br /> (?� <br /> D. RESPONSIBLE'PERSON/BUSINESS <br /> NAME OF BUSINESS: G <br /> CONTACT PERSON: l/�P.i� PHONE: <br /> I <br /> PHYSICAL ADDRESS: 41.10-1 <br /> -C- <br /> s c4-f_- <br /> MAILING ADDRESS: <br /> E. DESCRIPTION <br /> TYPE OF DISCHARGE: <br /> VOLUME: <br /> 1 <br /> CHEMICALS: <br /> A bad v z <br /> CIRCUMSTANCES: <br /> F. ACTION TAKEN <br /> SITE DISPOSITION <br /> CAS (10a-6 �u-r�vd C Uf.-d df �) L.AV 6- M4 wW-� pa-� •� <br /> ciLe..�.•r. t jw�i� f <br /> Revised 08/02/12 Page 1 of 2 NOTIFICATION OF HAZ WASTE DISCHARGE <br />