Laserfiche WebLink
*.1 <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE ` <br /> HEALTH & SAFETY CODE 25180.7 n <br /> A. EMERGENCY LEVE II' III - PHS-EH LOG # <br /> ( ' cle One) <br /> .B. SOURCE OF INFORMATION - - - - --- <br /> Name: L Phone: 40 907 9- 330 o <br /> Company: 6w G <br /> Address: L /y To ys"J73 <br /> Designated Employee Name: Phone: ) <br /> Reporting Agency Name- . —5'r <br /> Address: O4 e• <br /> C. LOCATION AND DATE OF DI;SSCHARG ll ` <br /> Location: 3,-71.-�-, Al- e4 lo4"; rk <br /> (Best Physical Des 'ption) or County) Circle One <br /> Date of Discharge: <br /> Date Notified: Time: �- <br /> D. RESPONSIBLE PERSON/5LISINESS ` <br /> Name of Business: d o? <br /> Contact Person: C r Telephone: ( og)S<<S3 — p k <br /> Physical Address: <br /> Mailing Address: PD <br /> E. DESCRIPTION #' ` <br /> Type of Discharge: <br /> Volume: <br /> Chemicals: <br /> Circumstances: <br /> F, <br /> F. ACTION TAKEN <br /> - ri <br /> SITE DISPOSITION XY G <br /> EH 22 013 (Rev.4/91) <br />