Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> /(� � Pys. <br /> �. <br /> A. EMERGENCY LEVEL: II III � -EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: ,l�FI�J Phone: F <br /> Company: 4&'A�.Y130-1 <br /> Address: P U- ,3-''r <br /> Designated Employee Name:_ - -'ice_ r'P-Gvr 44- Phone: 9•� �u <br /> Reporting Agency Name: <br /> Address: aWr-5 A/ 5i44Sorb 4��1�/ <r-- s-rv� K'ToiJ --A <br /> C. LOCATION AND, DATE OF DISCHARGE <br /> Location: 1 LI go':9 a-,, /-z- <br /> (Best <br /> Z(Best Physical Description) (City or County) Circle One <br /> Date of Discharge: <br /> Date Notified: /(-77/ ( Time:_-�� a <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: <br /> Contact Person: Telephone: ( ) 7,!53--646c <br /> Physical Address: G#!cy 131-:4-4� i--&4-1 ��ac� , zA g 16c,-�, <br /> Mailing Address: 14,4r�ArC_ /3c .tj, �r1;�u��._,� ,�.!1 C7 fW/, <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: <br /> Chemicals• 1=��•r�e�- ti �1�D��x -i / <br /> Circumstances: <br /> /1r3avc 68'7`iv/) r',c i/Jvr!F��D T•Fk� o��iGF_ ��� ���ir,.4�'!YC . <br /> F. ACTION TAKEN ci/Vi�E.eG,c'��i�1 t� P�o��'�:T GyGS 't- �'�s�✓E; �' �u�z�, <br /> /„1•YVy� /Q.El�Gy' -d1 G�' !'?•-� N�ccJ O�(�S l�i�h7-F'-v!.�iG�( Cc�VSG'G=Ti17�eC'f /-�id� <br /> 14 <br /> LOi`t i/�TG� f�¢G!�i�!Yr/�-�-��'�u�9L. G��-i,E.�° C�•�s�Gi•TY LU/1f%/�-�r�f'�17 SITE DISPOSITION <br /> DISPOSITION <br /> ,4-�Y✓� /Z!>,��G� TU T� �' �.�i�O.1Li z+5/il i Ei'� �:� <�i1Tz"����F . �%Q%i-�.� - <br /> . iYii��TiGT'i��� /1Liyi7/ JzL`^iJi/,f�?ic sc/ /�y< 13E <br /> EH 22 013 (Rev.4/91) <br />