Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> NOTIFICA" )N OF HAZARDOUS WASTE D'CHARGE <br /> I�MALTH & SAFETY CODE 25180.r-O <br /> A. EMERGENCY LEVEL II III PHS-IH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> ,. Original Source: LrjN�tifi Telephone: — <br /> Reporting Agency Name: 1 J PILE -- <br /> Agency Contact: ��jjckC� l�u� i 4Telephone: <br /> Address: ��C. N AND DATE OF D/ ISCHARGE <br /> r�1 of fJh�I XiN �C�1 r tJ'r�(� ! Co <br /> Location: .I 41,. <br /> est Physical Description) (City or County) <br /> Date of Discharge: — U"ktj,!,wr4 <br /> Date Notified: zt/f _ Time: L50 /2"' <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business ...� �"" t•"1 - <br /> Contact Person: CZrq,,i arn�.s�:+� Te,ephor:e: (,err- ) – <br /> Physical Address: ?d'7 E. DESCRIPTION <br /> Tyle Release: <br /> Chemicals: <br /> F. ACTION TAKEN <br /> 11/7(l,-- - <br /> �,--- ha <br /> — �f' C��hO^•�-�C li,- �(� 7 �G�r �Y %r G �• It I C. r:� Y.x <br /> r/ <br /> (- <br /> 1 ���V/V lVi 7j t i s <br /> ,�Tr --_ -- - -- <br /> EH 22. 013(Rev. 02/90) <br /> a <br /> 15 <br /> E, F4 U r, =- <br />