Laserfiche WebLink
r„w SAN JOAQUIN COUNTY •./ <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: 0II III PHS-EH LOG # C ` <br /> (Circle One) <br /> B. SOURCE PF INFORMATION ���,�' <br /> Name: Phone: l�J <br /> Company: /1'h-7 <br /> Address: 7— _ ,Ca 9-7653 <br /> Designated Employee Name: Phone: <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DI CHARGE <br /> Location: ,l3 D <br /> (Best Physical Description) (City r County) Circle One <br /> Date of Discharge: 4,e ` <br /> Date Notified: 5. 23 9i Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: ,O/W 46 1,1odzuz-,4 <br /> Contact Person: 412e_ Telepho : 516 — JIF/ <br /> Physical Address: a1.30 GW. Gl/4.o �a�. v�9 -n• f'SLo 6 <br /> Mailing Address: «-� _ <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: <br /> Chemicals: <br /> Circumstances: <br /> i <br /> F. ACTION TAKEN <br /> SITE DISPOSITION 946 -� - --•� � <br /> -- �1ION- crC G s T — <br /> ,2u) <br /> EH 22 013 (Rev.4/91) <br />