Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180 . 7 <br /> A. EMERGENCY LEVEL: II III <br /> HEALTH DISTRICT LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: <br /> Ck V�""`"^°" Telephone:P (2—`► )q52 3260 <br /> Reporting Agency Name: �.. coq <br /> g�•� Lac... <br /> Agency Contact: <br /> Telephone: (2oq ) yb&-3yko <br /> Address : I bo � � ��ael-4o� �j 2�Jq <br /> K S-bt� �... c A `1S Zoe <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 6 (o )j . <br /> (Best Physical Description) / <br /> (City or County) <br /> Date of Discharge: <br /> Date Notified: _ (11A <br /> Time: ..,���.,o„•.,., <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business <br />. To o+� Tow , <br /> Contact Person: R <br /> ay �roTelephone: (7-0q ) qsz - <br /> 3z�o <br /> Physical Address : 1v- <br /> �sz� l <br /> E. DESCRIPTION <br /> Type Release: <br /> Re`ega-e <br /> Volume: \ <br /> Chemicals : e <br /> �VJ I'e�v� � QHo C.c✓b oN <br /> h. ACTION TAKEN <br /> w.V 1 t L 1 <br /> 1 c ✓�C q v*--.e (1, I� <br /> 1 <br />