Laserfiche WebLink
r <br /> SAN JOAQUIN COUNTY <br /> NOTIF[CATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> E � , <br /> A. EMERGENCY LEVEL II III PHS-EH LOG # <br /> q77- <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Phone: �`1 7 - /1 (,3 <br /> Company: <br /> Address: l ra )z <br /> Designated Employee Name Phone: (_) <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: L4 L () 9, Q <br /> (Best Physical Description) City r County) Circle One <br /> Date of Discharge: LLQ �-- <br /> Date Notified: 6 o Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: Wa4,-aej-�-•. <br /> Contact Person: Telephone: 9 <br /> Physical Address: _ 1313 - <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge. _ L•�� c���.t` �--c� - -'- - - - �'�-�-� -CIS_T� <br /> Volume: <br /> Chemicals: <br /> Circumstances: - d-11 <br /> F. ACTION TAKEN LLA <br /> l <br /> SITE STATUS - -4� <br /> EH 22 013 (Rev.4;91) <br />