Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INF RMATION <br /> Name: � ^ Phone: <br /> Compare}. <br /> Address: _ _ _ _ L(-_10 64 CLIh Ec L-c ul e She lU_y.?. n4p S-ft�F�_5�S a <br /> Designated Employee Name: Phone: 1 <br /> Reporting Agency Name: <br /> Address: i <br /> C. LOCATION AND DATE OF DISCHARGE <br /> • <br /> Location• 5 -(_s�n( <br /> (Best Physical Description) �ty op County) Circle One <br /> Date of Discharge: �L-�1Y1 <br /> Date Notified: ',;L— PO Time: <br /> i <br /> D. RESPONSIBLE PERSON/BU INESS <br /> Name of Business: <br /> Contact Person: Telephone: <br /> Physical Address: VI P_ c, Ct <br /> Mailing Address:- • r' Aa2a <br /> E. DESCRIPTION <br /> Type of Discharge: ( t� ..,.._.�...�..�_.., <br /> Volume: L1111 � <br /> Chemicals: <br /> Circ tances: S ( <br /> F. ACTION TAKEN S L a <br /> SITE DISPOSITION <br /> �- <br /> CX C� <br /> EH 22 013 (Rev.4/91) <br />