Laserfiche WebLink
A. <br />Lim <br />C. <br />E. <br />F. <br />� S � <br />AN JOAQUIN COUNTY <br />NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br />HEALTH & SAFETY CODE 25180 7 <br />o <br />EMERGENCY LEVEL:0II III PHS -EH LOG # i q 9 <br />(Circle One) <br />SOURCE OF INFORMATION <br />Original Source: ,5 , fI„r„ Telephone: <br />Reporting Agency Name: s3G.cr .?Dr GL1in Ocr�/cc o //L, ' � yt&s <br />Agency Contact:_ �,`�, / �T Telephone: (moi—) V6je- =3,?r go j <br />Address: _ l/moi F ,�,�. 1�,4o e <br />LOCATION AND DATE OF DISCHARGE <br />Location: <br />(Best Physical Description) (City or County) <br />Date of Discharge: <br />Date Notified: �917,2 <br />5_eq <br />RESPONSIBLE PERSON/BUSINESS <br />Time: <br />Name of Business 612 4 )lPr/oo /.a 4,e <br />Contact Person: a rn Qy„i v Telephone: -9'(,p `!// y <br />Physical Address: k9a fer /oc) led_ <br />DESCRIPTION <br />Type Release: %=a , �, d /arc ct5;o o >les <br />Volume: <br />Chemicals: - - ar %ese/ g rP c, /�L, /.►, , ..,✓a,,o , _ - - <br />ACTION TAKEN <br />In 0 A <br />C/ <br />EH 22 03 (Rev. 7/89) <br />