Laserfiche WebLink
C COFIY <br /> `/ SAN JOAQUIN COUNTY Saw <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: Q II III PHS-EH LOG # !Z <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Phone: (_) <br /> Company: <br /> Address: <br /> Designated Employee Name: L .MzfnC_ Phone: <br /> Reporting Agency Name: <br /> Address: .44.S _-- <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 10 f v ati 7� <br /> (Best Physical D scription) (City or County) Circle One <br /> Date of Discharge: ov-- n,� <br /> Date Notified: —% Time: ri <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: S <br /> Contact Person: f.�/�1 G�c�cam_ Telephone: CEO) 73-- s U-0 <br /> Physical Address: ceq- <br /> Mailing Address: �1a.�e G� dr J <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: w - <br /> Chemicals: ~{ <br /> Circumstances: Co fC" <br /> F. ACTION TAKEN �a� Sa.ri.�.•� ,(er� 0 -k°'w_._ �t1 <br /> SITE STATUS '+ J2 8L <br /> EH 22 013 (Rev-4/91) <br />