Laserfiche WebLink
f SAN JOAQUIN COUNTY <br /> r " NOTIFI(,,,.r1ON OF 11.ALARDOUS WASTI )1SCI1ARCE <br /> iir�ALnt & SAFETY CODE 25irb <br /> A. EMERGENCY LEVEL II IlI PISS-EH LOG # <br /> (Circle One) <br /> I3. SOURCE OF INFORMATION <br /> Original Source: .(h ��( Telephone: <br /> Reporting Agency Name: <br /> Agency Contact I� C� �sC_��_ Telephone: � <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location. 0 J-7�Al � / <br /> (Best Physical Descri tion) (City ogaun <br /> Date of Discharge: <br /> Date Notified: Time: y ' <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business 111L Ftt-e. e <br /> Contact Person: f Telephone: -- <br /> Physical Address: �� D c <br /> E. DESCRIPTION _ <br /> •ape Release: , w 2�-tt" �1 <br /> Volume: <br /> Chemicals: <br /> F. ACTI���`�►� �i 2G,��, 0 2� C�S�� S �&-L- 624">4-6 3Ll 9 �*ffze'. <br /> 9 ; c a,�, &,cIL v- <br /> �z <br /> 1. <br /> UdA /4 <br /> a12- <br /> 3) f� (� <br /> E-H 22 013 (Rev. 02/90) <br />