Laserfiche WebLink
SAN JOAQUIN COUNTY \� <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE J- 1 <br /> HEALTH & SAFETY CODE 25180.7 _ <br /> A. EMERGENCY LEVEL:;0I II III PHS-EH LOG #�7 <br /> (Circle One) <br /> B. SOURCE OF INFORMATION qs�_ oaG <br /> Name: Ib { 1' Wld f ( i s 17ay �( i r� Phone: (� <br /> Company: t ' <br /> Address: 1 o3 \/J �Ir 11 1 -A f,� SurA` (+ f �� 9S207 <br /> Designated Employee Name: Phone: (_) <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 2;08 N- G(-a v t / <br /> (Best Physical Description) Cior County) Circle One <br /> Date of Discharge: �, nk^` -LAD v, <br /> Date Notified: Lena ci i ( �;n* Time: [0 00 �n <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name e€�: de-S �0 ax <br /> Contact Person: SMvvta Telephone: ( <br /> Physical Address: �4-7 E FLWS ?-C9 fkO cILAI'rl GA U S 2 05 <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: tA R l/-0 M-2Y-) <br /> Volume: k n <br /> Chemicals: a 1 <br /> Circumstances: t-.e eke �mm Cwi DIST1A 'r— eLm—lal� ria fi� <br /> F. ACTION TAKEN &ASr, cACge bu d�tv OJd(S (l� ��8�j Qr�l j <br /> Gl•.kt-Fe-G�� <br /> SITE STATUS i i n u e <br /> f <br /> EH 22 013 (Rev-4/91) <br />