Laserfiche WebLink
R • SAN JOAQUIN COUNTY • <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL I II III PHS-EH LO <br /> (Circle One) <br /> B. SOURCEPF INFORMATION <br /> Name: Phone: <br /> � <br /> ( - E3 <br /> Company: <br /> Address: <br /> Designated Employee Name: Phone: (� <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: Lo/O GU. GGt-Zc <br /> (Best Physical Description) Ci or County) Circle One <br /> Date of Discharge: <br /> Date Notified: 8 G 9 Time: C/'O6 c <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: <br /> Contact Person: .e% e -�T Zewls Telephone: (� <br /> Physical Address: _ <br /> Mailing Address: 3 5- Lodes, fSaf�U <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: �cv-- <br /> Chemicals: <br /> Circumstances: cu c <br /> G. T. <br /> F. ACTION TAKEN <br /> SITE DISPOSITION _ <br /> z <br /> EH 22 013 (Rev.4/91) <br />