Laserfiche WebLink
o, .: SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE,-'-, D <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVE I III PHS-EH LOGO—9(6! 1\3�e One) <br /> i f3 a <br /> B. SOURCE F INFO TION <br /> x'67 -1335 <br /> Name: Phone: <br /> Comp• - <br /> Address: e -ice _y_c avp- t nrQe a q- <br /> Designated. Employee Name: Phone: (� <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATF OF PISCHARG,E <br /> Location•_ VV.6R <br /> . VIA% <br /> •(Best Physical Description) •ty r County) Circle One <br /> Date of Dis�chamei 444k. <br /> Date Notified: ( Time: 70 <br /> D. RESPONSIBLE PA�BqSINES$ ,Name of Businesj/��- -L <br /> Contact Person: Telephone: CyPhysical AddressL-A <br /> Mailing Address: S <br /> E. DESCRIPTION <br /> Type of Disch ge: GAAau-l. a'w` F .t-C C0-� <br /> Volume: <br /> Chemicals: <br /> Circumstanc 1 <br /> F. ACTION TAKEN <br /> SITE DISPOSITION / ,0 <br /> EH 22 013 (Rev.4/91) <br />