Laserfiche WebLink
ValaVI4pqr i.NO la4vu U41 vw4 a7YK1P11 tfAOL . <br /> SAN JOAQUIN COUNTY *„,o/ [� <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 J <br /> A. EMERGENCY LEVEL: 01I III PHS-EH LOG <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Naive: Phone: �) 719W-164D <br /> Company-. <br /> Address: /io •. 7 T <br /> Designated Employee Name: Phone: (� <br /> Reporting Agency N <br /> Address: M.Ez 3 <br /> C. LOCATION AND DATE OFD CHARGE <br /> Location: 7 C b44ZD Avg <br /> (Best Physical Descri 'on) r County) Circle One <br /> Date of Discharge: <br /> Date Notified: aritz Timm e: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: A -r- <br /> Contact Person: Telephone: (gam) 4P •e±Z <br /> Physical Address: AvE. <br /> Mailing Address: 7 Co <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: <br /> Chemicals: <br /> Circumstances: <br /> X. <br /> F. ACTION TAKENtL�P���rs.�14 ?74s�1� GtwO•3 -�- a�r� <br /> SITE STATUS i4 •r— <br /> 4kMoff4c:kC� -?"for <br /> ...T- <br /> EH 22 013 (Rev4/91) <br />