Laserfiche WebLink
SAN JOAQUIN COUNTY, <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARG <br /> La PY <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: II `III PHS-EI•i LOG � <br /> (Circle:ane) <br /> B. SOURCE'OF INFORMATION <br /> Name: <br /> Phone: 3% P <br /> Company: <br /> Address• <br /> Designated Employee Nan-f6: Phone: <br /> Reporting:Agency Name: .y <br /> Address: f <br /> C. LOCATION ANIS DATE OF DISCHARGE <br /> Location. r& S c". •. ! <br /> {Best Physical Description) ;i ity r County) Circle One <br /> Date cif Discharge: Gtr <br /> Date No6iet3. Time: to pddt'. <br /> i <br /> D R.ESPC)NSIBLE PERSONS/CI SINESS l <br /> Nance of Business: 7 a 0'_,5 2k4l ila) <br /> Contact Pe3son: Telephone: C <br /> Physical Address: 3 � <br /> Mailing.Address: -' <br /> E. DESCRIPTION <br /> Type of Discharge: ;a <br /> Volume. .s+..h— <br /> Chemicals: <br /> Circumstances: <br /> F. ACTION TAKEN '0j4'&_ a_ .,a.. <br /> SITE. DISPOSITION /• � .-�-r� ;� ,. c� <br /> f <br /> EH 22 013 (Rev.4/91). <br /> F� <br />