Laserfiche WebLink
..� ` SAN JOAQUIN COUNTY r <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> i <br /> A. EMERGENCY LEVELP,'rclle <br /> I III PHS-EH LOG #COne) C <br /> B. SOURCE OF INFO#MATION <br /> Name: 1-411 K"Onf r Phone: Q I) <br /> Company: (,Atc5 <br /> Address: tLAD n Su (a Mado5kz <br /> Designated Employee Name: Phone: C ) <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: lqliDo 'lI M / <br /> (Best Physical Description) (City or o ty Circle One <br /> Date of Discharge: A '(X As n <br /> Date Notified: Time: 'q., <br /> r <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: DyjzaS— Lac t5G — <br /> Contact Person: Telephone: ( �I <br /> Physical Address: V41tO W. Sck0I <br /> Mailing Address: FO -504 2,30 �' C C 53 <br /> E. DESCRIPTION <br /> Type of Discharge: tp-aK — <br /> Volume: OaK <br /> Chemicals: .nL5o I[Yom. <br /> Circum�sstances: �Lew L` v f- 50` 'OLlCIl <br /> e Cj <br /> F. ACTION TAKEN <br /> ;r <br /> k <br /> SITE STATUS <br /> a Y' v� SFS <br /> p-n <br /> EH 22 013 (Rev.4/91) <br />