Laserfiche WebLink
T FILE COPY <br /> SAN JOAQULN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH &'SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I) II III PHS-EH LOG# 99 - 154 <br /> (Circle one) <br /> B. SOURCE OF INFORMATION <br /> Name: bo <br /> C Phone: (?n� 339 -JAPW3 <br /> Company: <br /> Address: 5, ir'- <br /> Designated Employee Name: Phone: <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: q TT S. 1�-Q�✓rnovr{'' � <br /> (Best Physical Description) ity r County) Circle one <br /> Date of Discharge: ICI <br /> Time: 13 <br /> Date Notified: Ge Z5 X951 <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: <br /> Contact Person: Phone: - <br /> Physical Address: 01-: 5 � E6; <br /> '- I , <br /> Mat Iing,Address: <br /> E. DESCRIPTION <br /> Type of Discharge: 11 <br /> Volume: - 3 <br /> Chemicals: CArcid- <br /> circumstances: miL•-+,•�kt� D� �" � = = '^�D d`� � <br /> F. ACTION TAKEN <br /> SITE DISPOSITION <br /> EH 22 013 (Rev. 08/20/98) <br />