Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS 'WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVELI II III PHS-EH LOG R <br /> Ircle one) <br /> B. SOURCE OF INFOR?vLATION <br /> Name: Phone: (g11Q) - <br /> Company: "C)eIn C <br /> Address: <br /> Designated Employee�Ee: Phone: <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> 1. -1Fr0LCAA <br /> Location: <br /> (Best Physical Description) ity ounty) Circle one <br /> Date of Discharger1a; P5 <br /> Date Notified: Time;_ <br /> D. RESPONSIBLE PERSON/BUSNESS <br /> Name of Business: - <br /> Contact Person: P-RA2 f, Phone: <br /> Physical Address: <br /> Mailing Address: <br /> E. DESCRIPTION <br /> T}-pe of Discharge: <br /> Volume: nl�n vx� <br /> Chemicals: <br /> Circumstances: <br /> F. ACTIONAk <br /> TAKEN <br /> SITE DISPOSITION <br /> C ' <br /> EH 22 013 (Rev. 08120198) <br />