Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> -17.I <br /> G <br /> ti EIIRONMENTAL HEALTH DEPARTMi!NT ' <br /> ` 304 East Weber.Avenue,3d Floor, Stockton,CA 9520 . 2708 U <br /> w (209)468-3420•Fir:(209)464_-0138 Web:w�3w-col`I'san joaquin.ca.uslehd i <br /> BARGE <br /> NOTIFICATION OF HAZARDOUS WASTE DISC <br /> California Health &'Safety Code,Section 251. 80.7 <br /> A. EMERGENCY LEVELdl <br /> (Circle One)' I' <br /> B. SOURCE OF INFORMATION �I �3 y <br /> Phone: (0007) <br /> Name: <br /> Company: � j � Zip Code: s Z <br /> Address: City. <br /> Designated Employee Name: <br /> Design <br /> S�C EFi D <br /> g Agency Name: <br /> �!I ,LI <br /> �a Z <br /> Jc.i Zip-Code: � <br /> Address: �� "I City: <br /> TION AND DATE O DI CHARGE <br /> C. LOCA c�I Count <br /> •t or <br /> zz � <br /> Location: i - {Circle One) <br /> (Best Physical Description) <br /> L1,Ak4 Q`% �"'� Sec' <br /> Date of Discharge: oDate Notified:-l!reee1 �a�ir to Time: <br /> I <br /> D. RESPONSIBLE PERSONIBUSINESS L—CL40 <br /> Name of Business: I. ; phone: <br /> Contact Person: S �6a City �a�I�� Zip Code: 'T <br /> Z { t <br /> Physical Address:. II �h ( Zip Code: <br /> Mailing Address: <br /> 1( ��-' City:, 3, <br /> E. DESCRIPTION 1� . <br /> Type of Discharge: <br /> i <br /> Volume: <br /> ?� <br /> Chemicals: �1- {,,) <br /> r 5 Cater <br /> ces: <br /> . Circumstan s�r <br /> F. ACTION TAKEN: <br /> I' k <br /> SITE DISPOSITION: <br /> �! 'I Notification of Hoz Discharge <br />