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• SAN JOAQUIN COUNTY • <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHAR� <br /> HEALTH & SAFETY CODE 25180.7 <br /> u� <br /> A. EMERGENCY LEVEL: II III PHS-EH LOG # <br /> ( cle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Phone: (_) <br /> Company: <br /> Address: <br /> Designated Employee Name: Phone: Z <br /> Reporting Agenc Nam : <br /> Address: T 1/11 tlu ��l�tia o f n l0/ U <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: Il S30y/. E_ghf <br /> (Best Physical Descriprt�i66n (City or oun Circle One <br /> Date of Discharge: I 0-12 MZ <br /> Date Notified: Time: 2 % 57 .0m <br /> D. RESPONSIBLE PERSON/ USINESS <br /> Name of Business: - l� <br /> Contact Person: Telephone: <br /> Physical Address: <br /> Mailing Address: <br /> E. DESCRIPTION 4 &0147—- n� <br /> Type of Discharge: 2 3 e bL�e <br /> Volume: 2-3 <br /> Chemicals: <br /> Circumstances 5 <br /> F. ACTION TAKEN <br /> �,,,,.i LP W c2n (' �n�,��c,�-� _� 1�-c-ten s • <br /> SITE DISPOSITION P.M.P <br /> EH 22 013 (Rev.4/91) <br />