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SAN JOAQUIN COUNTY <br />NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br />HEALTH & SAFETY CODE 25180.7 r <br />A. EMERGENCY LEVEL II III <br />ircle One) <br />B. SOURCE OF INFORMATION <br />Company: <br />Address: <br />Designated Employee Name:_ <br />Reporting Agency Name: <br />Address: yL� S N <br />C. LOCATION AND DATE OF <br />T�Z�D <br />11 <br />f� <br />F <br />VIh <br />(Best Physical Description) <br />Date of Discharge: <br />Date Notified: <br />"::;F <br />RESPONSIBLE PERSON/ USI <br />Name of Business: <br />v+-> 11711h <br />Contact Person: <br />� Sen jo <br />Physical Address: <br />321:2 s. <br />Mailing Address: <br />Po Gov 6q 8 <br />DESCRIPTION <br />Type of Discharge: <br />(% <br />Volume: <br />v�✓� <br />Chemicals: <br />olYScl -37 <br />PHS -EH LOG # �l3 <br />n <br />Time: �,,'o0 <br />l�> <br />Phone:(___) <br />Phone: (Zo`r) 6&-033 <br />or County) Circle One <br />Telephone: (ae) S q" • V 2 6 <br />1 if3 6 L <br />EH 22 013 (Rev.4/91) <br />