Laserfiche WebLink
�oP4�IN co SAN JOAQUIN COUNTIp <br /> ENVIRONMENTAL HEALTH DEPARTMENT L D <br /> ` 600 East Main Street Stockton •CA 95202-3029 <br /> ' (209)468-3420•Far:(209)4640138 • Web:www.sigoy.org/ehd <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHI4R,GE' <br /> A. EMERGENCY LEVEL I X I EHD LOG# 10-0 <br /> B. SOURCE OF INFORMATION <br /> NAME: ��D�C' �,(,� � PHONE: yoq'9$'L-t9to -13 <br /> COMPANY: �',�-� P } Tc�+ 1'y' CITY: <br /> ADDRESS: O?.! �hGZ45'J►'I nl 'Vey <br /> DESIGNATED EMPLOYEE NAME: PHONE: <br /> REPORTING AGENCY NAME: <br /> ADDRESS: <br /> C. LOCATION AND DATE OF DISCHARGE 7T�� <br /> LOCATION: <br /> /DylrcQf'c'!,I Vt'-+�� CITY )C I Incorporated <br /> Unincorporated <br /> DATE OF DISCHARGE: <br /> DATE NOTIFIED: tf^to_ /p TIME: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> NAME OF BUSINESS: <br /> CONTACT PERSON: o u <C. PHONE: Zo 9- cr V2-- 92D -2 3 <br /> PHYSICAL ADDRESS: ' 4m A,, <br /> MAILING ADDRESS: PC RoxC-t2-19 <br /> E. DESCRIPTION <br /> TYPE OF DISCHARGE: p <br /> VOLUME: <br /> CHEMICALS: Yn O <br /> CIRCUMSTANCES: <br /> F. ACTION TAKEN <br /> 'FaGI'1ily <br /> �-ie cr! an51 �7tc �jmwcr ca �ac wee <br /> ctN Q cQI'Sl+�j°� -f (� ci Ir 5¢n �qr. o�{'sl�t . <br /> SITE/DISPOSITION <br /> G1 eG ln�n�D GDS--iD�Ci�[ � <br /> ER RECORD MODIFIED Revised 05/012007 <br />