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A. <br />C. <br />91 <br />SAN JOAQUIN COUNTY <br />NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br />HEALTH & SAFETY CODE 25180.7 <br />EMERGENCY LEVEL:I� II III PHS -EH LOG <br />(Circle One) <br />SOURCE OF INFORMATION <br />Phone: �o�( (a -39L? <br />Designated Employee Name: l ui' 4,` c, Ref C -.4r, Phone: V35 <br />Reporting Agency Name: <br />Address: <br />LOCATION AND DATE OF DISCHARGE Z� J <br />Location:.3 % D �-- /-r' tri irvLr2 , / <br />(Best Physical Description) <br />Date of Discharge: / r�t —16 — 9/ <br />Date Notified: ?/ Time: 3:00 ic <br />RESPONSIBLE <br />Name of Businc <br />Contact Person <br />Physical Addres <br />Mailing Address: <br />(Ci r County) Circle One <br />E. DESCRIPTION <br />Type of Dische <br />Volume: <br />Chemicals: e, <br />F <br />EH 22 013 (Rev.4/91) <br />