Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180 . 7 <br /> A. EMERGENCY LEVEL: I II III HEALTH DISTRICT LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> p <br /> Original Source: �e CG�t1rt 9y�,o r, -nom Telephone: <br /> Reporting Agency Name: SAiv ,7214j lk /;cot/. 1)ie7.</C1— <br /> Agency Contact: S„/CCp��yez Telephone: (Zal <br /> Address : P O >!G 70� CA 9C3 <br /> C. LOCATION AND DAIE OF DISCHARGE <br /> Location: L6 Q / S'IOCL'T/✓� GA 9S"ZOG <br /> (BEst Physi al Description) (City or County) <br /> Date of Dischar. a : d.a.✓ <br /> Date Notified: Time: 14�14 %3U/�lZj <br /> D. RESPONSIBLE PER ON/BUSINESS <br /> Name of Busines ©MG/.e��7 19/1'2 <br /> Contact Person: �PEGGey cr/YuT Telephone: (7-0 ) <br /> i <br /> Physical Address : /L7 <br /> �r <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume : (/N/ i✓ <br /> Chemicals : CISOZisoe- <br /> F. ACTION TAKEN rim �iLrolhyr� •= 5 /ra j� �" r`� O �' `� <br /> R 4F4 5-i CtSSeSSr//n G✓i// 1, e I?z /u i2rc' A0 <br /> A'S {-te-e m /%Z e-,�l h e ro rsa <br />