Laserfiche WebLink
t ov <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> D <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG # P1,;7 16Y) <br /> ( ircle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Phone: (. ) <br /> Company: <br /> Address: <br /> Designated Employee Name: 6•'FLtrKQ Phone: 3 I <br /> Reporting A ency Name: xvl 1 Z IkA-4L Sis- 6AU- eA 1 <br /> Address: •0 • 3g g6Zd1 -038 <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: �q 9 O,16N-1 W aV / +0 C� <br /> (Best Physical Descri tion) Ci 'or County) Circle One <br /> Date of Discharge: L.�� RukI in <br /> Date Notified: 0.7- 6-2 Time: 9,.DM�2- <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: S Fargo <br /> Contact Person: r D Telephone: Z( f 3) �53- 3265 <br /> Physical Address: MoD Los ►'cul e DT 007 <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: VL 6wy) <br /> Volume: U V\, <br /> Chemicals: n <br /> Circumstances: ( AiitW� Vl vio � t <br /> �, Vv►e v-- 1 s - S PiVP cA <br /> /� a4Q*- C,On m ria -a( V� J Q S o li�Z UBYt�'1� evt�S <br /> F. A ION TAKEN <br /> SITE STATUS S< laaJ ` nL LOca, I V& 717 <br /> EH 22 013 (Rev.4/91) <br />