Laserfiche WebLink
SAN JOAQUIN COUNTVw' <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> l HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: II III FHS-EH LOGY (� <br /> ( ircle one) <br /> B. SOURCE OF INFORMATION <br /> Name: ,4e\ M -e- e—r Phone: (702) 3 r ? b_. <br /> Company: Ce-re--n, NS—SOCIA e <br /> Address,����5 Frrs f S'�ree Sir e 303 8�=�1� C� <br /> Desianated Employee Name: Phone: <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AIID DATE OF DISCHARGE <br /> Location: 3,;t-4 gra C 's1 Jd �a <br /> (Best Phv_sisal Des ption) 0 ity or County) Circle one <br /> Date of Discharge: ket w v-- <br /> Date Notified: R L-1 6 q- Time: :30 <br /> D. RESPONSIBLE PERSONIBUSINESS <br /> Name of Business: S r ��C,'�t a m[ c_S <br /> Contact Person: Phone: <br /> Phvsicai Address: '8' <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: d <br /> Chemicals: fa Ice t <br /> Circurnstances: G fo M L <br /> F. ACTION TAKEN �— <br /> SITE DISPOSITION �e r` Co���t v%A-L <br /> t V% r <br /> EH 22 013 (Rev. 08124198) <br />