Laserfiche WebLink
SAV JOAQULN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCE Q <br /> HE UTH & SAFETY CODE,25180.7 <br /> A. EiVIERGENCY LEVcc� <br /> II III PHS-EH LOG" 9q . 1-t� <br /> ele one) <br /> B. SOURCE OF INFORMATION . <br /> Name: <br /> Phone: ( ) <br /> Company: <br /> Address. <br /> Designated Emplo,ee dame: Phone: <br /> Reporting :agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: I zsag C21-4- <br /> (Best Physical Description) �or County) Circle one <br /> Date of Discharge: <br /> Date Notified: z, Sl-si G Time: If <br /> D. RESPONSIBLE PERSONIBUSINESS <br /> Name of Business: �Gln- � � <br /> Contact Person: Phone: 2x09 -Slz,3- 7cR23 <br /> Phvsical address: <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: IJe� <br /> Volume: <br /> Chemicals: <br /> Circumstances: <br /> ZRIAe. lid <br /> F. ACTION TAKEN <br /> SITE DISPOSITION <br /> EH 22 013 (Rev. 03/20/93) <br />