Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: 1 II III PHS-EH LOG# <br /> (Circle one) <br /> B. SOURCE OF INFORMATION <br /> Name: 2& <br /> LOO�®a.�[' ®`.� Phone: Rku) <br /> - <br /> Company:VAS <br /> Address:'D G S S�tL S`�`�c' <br /> Designated Employee Name: Phone: <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: '3`�� '��.`� / <br /> (Best Physical Description) (City or County) Circle one <br /> Date of Discharge: O! WtZs <br /> Date Notified: Time: ®$a® <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: <br /> Contact Person: Phone: <br /> Physical Address: <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: g 4a. <br /> Volume: V� <br /> Chemicals: <br /> Circumstances: <br /> F. ACTION TAKEN <br /> SITE DISPOSITION <br /> EH 22 013 (Rev. 08/20/98) <br />