Laserfiche WebLink
• SAN JOAQUIN COUNTY • <br /> NOTIFICA O Fy TION OF HAZARDOUS WASTE DISCHARGE (CO <br /> HEALTH & SAFETY CODE 25180.7 <br /> dircle <br /> PHS-EH LOGA. EMERGENCY LEVELOne) <br /> B. SOURCE OF INFORMATION Phone: <br /> Name: <br /> Company: <br /> Address: Phone: (� <br /> Designated Employee Name: [yam <br /> Reporting Agency Name: Sck, SCIA7 <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE f <br /> H/ �/oae. ofe A �/wkaP ed •/ w � e�' <br /> Location: <br /> (Best Physical Description) i or County) Circle One <br /> Date of Discharge: <br /> Date Notified: I/ T-'–`y 4 — Time: 3 ' ro P�1 <br /> D. RESPONSIBLE PERSON/BUSINESS we <br /> Name of Business: Telephone: <br /> Contact Person: �j <br /> Physical Address I R YS 2c l <br /> Mailing Address: 0:10- <br /> E. DESCRIPTION <br /> Type of Discharge: U tia K <br /> Volume: w n <br /> Chemicals: ` <br /> Circumstances: 0. <br /> F. ACTION TAKEN FTArgc <br /> aw <br /> SITE STATUS t gr z wv+eM e r4 - M <br /> EH 22 013 (Rev.4/91) <br />