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A. <br />q <br />C. <br />D. <br />ft SAN JOAQUIN COUNTY <br />NOTIFICAM4 OF HAZARDOUS WASTE D[SCQbE <br />HEALTH & SAFETY CODE 25180.7 Fly <br />EMERGENCY LEVEL:II III PHIS -EH LOO #� <br />(Circle One) <br />SOURCE OF INFOfMiA70 <br />Name: r <- Phone: �] 7 �� U <br />Company: <br />Address: <br />Designated Employee Name: Phone: <br />Reporting Agency Name: --Sea-, '^ L -i' <br />Address: `' z.e <br />LOCATION AND DATE OF D <br />(Best Physical Description) <br />(City o e One <br />Date of Discharge: 2 - 7 <br />Date Notified: z- -7 Time:, <br />RESPONSIBLE PERSON/B <br />Name of Business: h t {���,� <br />Contact Person:- Q.a Telephone: r -3 7 J= <br />Physical Address: w <br />Mailing Address:-�- <br />DESCRIP'TT^"f <br />Type of I <br />Volume: <br />Chemical <br />Circumst <br />SiT, DE POSITION <br />EH 22 013 (Rev,4/91) <br />-�- G• <br />