Laserfiche WebLink
SAN JOAQUIN COUNTY " <br /> NOTIFICATION OF IIAZARDOUS WASTE DISCHARGE <br /> I]EALTI-I & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG # q <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: ,Gl &�,n,�L,.,,_ <br /> �Jt �,�, Telephone: ( t�s ) <br /> Reporting Agency Name: dial .-,,,_r <br /> bJi�rdL, <br /> Agency Contact: Telephone: ( _) —4,6p)'3441 <br /> Address: � <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: (AC N6 <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: _ I'tj&jn( .1 JL I <br /> Date Notified: —J-1 11 1199p Time: U tJICp�,�t, <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business 'lll., /II� Al(7A)t� <br /> Contact Person: C-LAOT S p ( /►,� ) �4 <br /> Tele hone: N 1' 2 <br /> Physical Address: 01033 Yr i,Gi p�J�s' <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: <br /> Chemicals: <br /> r• ACTION TAKEN <br /> 'P <br /> S <br /> 1 (�Gtr�rXci �hS' <br /> k�1L� ( �A �I?L1 �� sf14-l�w4r CT1�r� pan .-� Sr <br /> Q <br /> EI-I 22 03 (Rev. 7/89) <br />