Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> NOTERCATION OF HAZARDOUS WASTE DESCHARGE <br /> HEALTH & SAFETY.CODE 25180.7 <br /> A. EMERGENCY LEVEL III PHS-EH LOG 0 <br /> (Circle One) . <br /> j <br /> B. SOURCE OF INFORMATION Phone CUA y6p-x`169 <br /> Name v o�,o/ss <br /> Company.. r.s. <br /> Address: Phare U <br /> Designated Employee Nazne <br /> Repozdng Agency Name: <br /> Address: <br /> C LOCATEON AND,DATE OF DISCHARIqE ��QV <br /> Location: Z 2+ /a S' In 3 <br /> (gest Physical Des e*ip 'on) <br /> (City or Code One <br /> Date of Discharge <br /> Dace .Nodfied Ti 95a4� <br /> D RESPONSIBLE PERSON/BuSaMSS <br /> ' Name of Business: w" moi a, <br /> Contact.Person: .-si.v, 16AT.elep e: C��9y9 <br /> ....Physical Address f wE - sect `�rS- <br /> Marling Address: <br /> DESCRIPTION <br /> Type of Discharge: <br /> Volume: ��aers� �o s S!o-3'a Cvo.4 S <br /> Chemicals: sE c <br /> Circumstances cc.os a.r.y o. �, • 8h o F <br /> F. .. ACTION TAKEi�T �Bso cv"w�s Pard a;l �rcr3� i��Es <br /> ST'I'E DISPOSITION <br /> E::I 22 013 (Rev.4/91) <br />