Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE i <br /> HEALTH & SAFETY CODE 25180.7 <br />� <br /> A. EMERGENCY LEVEL: I II III CC 00' 7jSV-ELOG'# <br /> (Circle One) <br /> B. SOURCE OF INFORMATION c= 2!D <br /> v /J2 �s Phone: <br /> Name: • <br /> Company: 5 <br /> Address: ?2 . <br /> Designated Employee N e= Phone: <br /> g Agency n <br /> Re ortiA Name- <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE r <br /> Locatiow., 20,V00 & <br /> (Best Physical e c 'ption) (City o oun Circle One <br /> Date of Discharge: -- <br /> Date Notified: 3 Time: ,'OCA •"1 <br /> D. RESPONSIBLE PERSON/ USIN SS <br /> Name of Business: <br /> Contact Person: .G. Fr-e i Telephone: (� o <br /> Physical Address. !�'Do <br /> Mailing Address: :5 <br /> E. DESCRIPTION <br /> Type of Discharge: �• • �• - � u' <br /> Volume: <br /> Chemicals: � <br /> Circumstancek L Ste` <br /> F. ACTION TAKEN 05 <br /> SITE DISPOSITION rrcw c <br /> 17 6717 <br /> EH 22 013 (Rev.4/92) <br />