Laserfiche WebLink
L <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II III HEALTH DISTRICT LOG <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: 0a_x Telephone: <br /> Reporting Agency Name: <br /> Agency Contact: L a� Telephone: <br /> LAddress: f��!• VdTi►� '9fJ,r)J <br /> C. LOCATION AND DATE OF �D)ISCHARGE <br /> Location: /1qAS_& A). w �f1�9 <br /> (Best Physidal `Descripton) (City yr County) <br /> Date of Discharge: <br /> Date Notified: '2 Time: �r• 3b�' • <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of BusinessL 0- <br /> Contact Person: T lephone: (� 3�q • 3 G 3 <br /> q a <br /> Physical Addre t V- 0' k C-t <br /> E. DESCRIPTION <br /> Type Release: <br /> . <br /> Volume. <br /> Chemicals; ° <br /> LF, TION) TAKEN <br />