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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISC[ Copy <br /> HEALTH & SAFETY CODE 25180.7 _ <br /> A_ EMERGENCY LE <br /> VEL II III PHS-EH LOG-9 <br /> (Circle one) <br /> B. SOURCE OF INFoRiMATION too <br /> d. V -Pd S[� Phone: <br /> Name: C <br /> Company: Ur <br /> Address: Phone: O <br /> Designated Employee Name: <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE r <br /> Z.� SoA A a C Ub <br /> Location: (Cit} or County) Circle one <br /> (Best Phvs'cal escnption n <br /> Date of Discharge: Time: <br /> Date Notified: <br /> -D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: KE Phone: <br /> Contact Person: <br /> Phvsical Address: <br /> Mailing Address: <br /> E. DESCRIPTION . <br /> T e of Disch rg LM <br /> � n <br /> y� <br /> Volume: L/ <br /> Chemicals: � <br /> Circumstances: <br /> Q <br /> F. ACTION TAKEN T` V <br /> 144 11;1vS <br /> liJ r <br /> OL 1111, <br /> w '+ • <br /> s � r <br /> SITf,DISPOSITION <br /> . I <br /> I'mJL <br /> r <br /> i <br /> I <br /> EH 22 013 (Rev. 08120198) <br />