Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> P.� NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> coHEALTH & SAFETY CODE 25180 . 7 <br /> A. EMERGENCY LEVEL:OII [II PHS- EH LOG # — <br /> (Circle One) <br /> B . SOURCE OF INFORMATION <br /> Name : JEeZy '/:=).S +4 0K Phone : (� 11 �8 pS3s <br /> Company:. .— . - <br /> Address : <br /> ompany: — . -Address : _ <br /> Designated Employee Name :_ Jc�ry �(csl , , oka Phone : 209 lt (ag- eggs <br /> n <br /> Reporting Agency Name : San Jocu G env <br /> Address : 3014 E �nlcbc� <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location : 1326 Como 1 le{o� ( ow / -T-rg� y <br /> (Best Physical Description) (City or County) Circle One <br /> Date of Discharge : uv\ know n <br /> Date Notified: �1uhc 112st Iqq� Time: lto54a ou�S <br /> D . RESPONSIBLE PERSON/BUSINESS <br /> Name of Business : lr \ S-t-cL,,. � o <br /> Contact Person: Kcf �� Telephone: (4Q ) ��g9 _ z89C� <br /> Physical Address : <br /> Mailing Address : `? O , 63 tOSlo �Iq o CA QQSU� <br /> E . DESCRIPTION <br /> Type of Discharge : <br /> Volume : <br /> Chemicals : <br /> Circumstances : Uhd <br /> F. ACTION TAKEN \wo undc n-. Un 3 tcs�4c� <br /> SITE STATUS m ( s s urt u `7 <br /> I�'lF2 rn ( ��-d-G�cr Q .S csirt u <br /> Qr�l��Or aen- Vl MCLa lYni 1 <br /> EH 22 013 ( Rev. 4/ 91 ) <br />