Laserfiche WebLink
1 SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> H q7� /4 <br /> A. EMERGENCY LEVEL: I It III PHS-EH LOG � 7 <br /> (Circle One) <br /> B. SOURCE OF INFORMATION t <br /> Name: '�►.� c h Awo.ty4-4a 1 L":5, Phone: <br /> Company-�nL .�:-yrs1�-'�,�t <br /> Address• <br /> Designated Employee Naive: I Phone: <br /> Reporting Agency Name: ! <br /> Address: 304 E. W rf-k>& . e= - I <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: moa v;kz . <br /> (Best Physical Des=' tion) (City Coun Circle One <br /> Date of Discharge: o ,7 <br /> Date Notified: v Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: _ -�-6mS : I?;!� _ <br /> Contact Person:-��, �e.��� 7-61 I Telephone: 0,?_Z.3J- <br /> Physical Address: jg, ,s u. �:hee-ry.xi-ir ASE <br /> Mailing Address: P0. r%o,c 631 �l/�,a�-c,� ea 9533E <br /> E. DESCRIPTION <br /> Type of Discharge: E <br /> Valuine: <br /> Chemicals- <br /> Circumstances: a ' <br /> I <br /> F. ACTION TAKEN "`rin� _ —�,a►�� ,,�;5 .- 4� .r�c;_ <br /> I <br /> I <br /> I <br /> I <br /> I <br /> SITE DISPOSITION I <br /> I <br /> I <br /> I <br /> I <br /> EH 22 013 (Rev.4/91) <br />