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SU0005259 SSCRPT
Environmental Health - Public
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SU0005259 SSCRPT
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Last modified
5/7/2020 11:31:35 AM
Creation date
9/6/2019 10:00:46 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
FileName_PostFix
SSCRPT
RECORD_ID
SU0005259
PE
2611
FACILITY_NAME
PA-0500469
STREET_NUMBER
5055
Direction
E
STREET_NAME
MAIN
STREET_TYPE
ST
City
STOCKTON
APN
15910007, 08, &
ENTERED_DATE
8/2/2005 12:00:00 AM
SITE_LOCATION
5055 E MAIN ST
RECEIVED_DATE
8/1/2005 12:00:00 AM
P_LOCATION
99
P_DISTRICT
002
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\M\MAIN\5055\PA-0500469\SU0005259\SSC RPT.PDF
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EHD - Public
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:5:SaYm F Kum <br /> Y L <br /> SAN JOAQUIN COUNTY `'� Qr s f <br /> r1 � <br /> t� I <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE ¢ <br /> HEALTH & SAFETY CODE 25180.7 9 <br /> A. EMERGENCY LEVEL:(DI III PHS-EH LOG # �— J <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Phone: (� <br /> Company: 5 F ��r orGF <br /> Address: <br /> Designated Employee Name: Phone: <br /> Reporting A�,ency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCWGE q Z?,5DUS <br /> Location: rvZG <br /> (Best Physicalescriptio (City o i ) Circle One <br /> Date of Discharge: a4w rt , <br /> Date Notified: `rte/rVTime: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: <br /> Contact Person: E Telephpne: (� <br /> Physical Address: 9Zo 47-,Gve2�z- /a v,<'T2z 3 z-(Z <br /> Mailing Address: - - <br /> E. DESCRIPTION <br /> Type of Disch ge: e- <br /> Volume: <br /> Chemicals: <br /> Circumstances: <br /> F. ACTION TAKENrcgG <br /> uP413 243 <br /> DrS svgs cYa � �a. r i.G��-r' <br /> SITE DISPOSITION r- <br /> o <br /> ear/" "r- <br /> EH <br /> __.. <br /> �d dGca-�f�rl G� <br /> EH 22 013 (Rev.4/91) <br />
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