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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> rr-�`� <br /> CC' OQ <br /> E <br /> A. EMERGENCY LEVEL: I 'II III PHS-EH LOG # /, D/ / <br /> l <br /> ( " cle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Phone: <br /> Company: <br /> Address: <br /> Designated Employee Name: Phone: <br /> Reporting Agency Name: <br /> Address: '�IA- , \,-1:p�pe-� <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: S-74- <br /> (Best <br /> -74-(Best Physical Description) ry r Countyl Circle One <br /> Date of Discharge: <br /> Date Notified: I Time: Lk.noCo�� <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: `:r—.-, <br /> Contact Person: Telephone: <br /> Physical Address: � r7G- <br /> Mailing Address: 4s^n� <br /> E. DESCRIPTION <br /> Type of Discharge: <L--a So <br /> Volume: <br /> Chemicals: <br /> Circumstances: �C_tz�,r.� <br /> raCC.�c�d� <br /> F. ACTION TAKEN <br /> SITE STATUS <br /> EH 22 013 (Rev.4/91) <br />