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A. <br />1.1 <br />0 SAN JOAQUIN COUNTY <br />NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br />HEALTH & SAFETY CODE 25180.7 COPY <br />EMERGENCY <br />n <br />^ <br />EMERGENCY LEVEL:�LI�' III PHS -EH LOG \# / �lu(—�0 O <br />(Circle One) <br />SOURCE OF INFORMATION <br />Company: <br />Designated Employee Name: <br />Reporting Agency Name: <br />Address: -!Y5 A . GA, -z:TE-q©u, � �-•�c� <br />C. LOCATION AND DATE OF <br />Location: <br />(Best Physical De: <br />Date of Discharge: <br />Date Notified: �� <br />D. RESPONSIBLE <br />Name of Busin( <br />Contact Person, <br />Physical Addres <br />Mailing Addres: <br />Time: 4:7 >'G� <br />Phone: (E-� �1�1-�lbyf <br />Phone: <br />w <br />County) Circle One <br />E. DESCRIPTION <br />Type of Discharge: <br />volume: z; -A% <br />Chemicals: 14t -ow <br />F <br />ueg5 <br />EH 22 013 (Rev.4/91) <br />