Laserfiche WebLink
SAN JOAQUIN COUNTY Li <br /> ? 'rNTVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street Stockton - CA °5202-3029 <br /> Q (209)468-3420 •Fax: (209)464-0138 . Web: v✓x w.s' ov.or d <br /> c4._ ,.. .•�P <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE w <br /> A. EMERGENCY LEVEL IXL I 1 ' EHD LOG# o <br /> B. SOURCE OF IN(FORMATION <br /> NAME: oPHONE: <br /> COMPANY: 1.tT1^ CITY: <br /> ADDRESS: 5-c 1 Iti rC/i <br /> DESIGNATED EMPLOYEE NAME: tV1 CWu, 1.� r PHONE: <br /> REPORTING AGENCY NAME: <br /> ADDRESS: �l C 7- 7,e" I <br /> C. LOCATION AND DATE OF DISCHARGE <br /> LOCATION: L�k X17; S T, f�, w'- CTTy n `� Inco orated I <br /> Best Physical Description —`"I"" (�]' 1�� <br /> • I Unincorporated I <br /> DATE OF DISCHARGE: U� r <br /> DATE NOTIFIED: L 1 TIME: { yr I <br /> D. RESPONSIBLE PERSONIBUSINESS <br /> NAME OF BUSINESS: <br /> CONTACT PERSON: '� �g�;�, PHO'NE: <br /> PHYSICAL ADDRESS: 1-S�l L1 i L <br /> MAILING ADDRESS: <br /> E. DESCRIPTION <br /> TYPE OF DISCHARGE: C�,l�✓C" nom` f {/y(�t <br /> VOLUME: � �, rtiflrJ <br /> CHEMICALS: <br /> CIRCUMSTANCES: <br /> F. ACT- IION TAKEN 1 ll <br /> ` <br /> SITE DISPOSITION <br /> ER RECORD MODIFIED RevjcB�DSlul(s�07 <br />