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A. <br />SAN JOAQUIN COUNTY <br />NOTIFICATION OF HAZARDOUS WASTE DISCHARG �. <br />HEALTH & SAFETY CODE 25180.7 V[py <br />EMERGENCY LEVEL: I II III <br />(Circle One) <br />SOURCE OF INFORMATION <br />PHS -EH LOG #_ _ �, 5 -//j <br />Name: l Phone: �) <br />Company: ARf o Kr C . <br />Address: <br />Designated Employee Name: Phone: �) <br />Reporting Agency Name: <br />Address: ;;S'E7,:: <br />C. LOCATION AND DATE OF DISCHARGE <br />161 <br />E. <br />F. <br />Location: / S 14- <br />(Best Physical Descriptio City or County) Circle One <br />Date of Discharge: 4?- lz� 9� <br />Date Notified: �- ,��9.� Time: ' ZS <br />RESPONSIBLE PERSO <br />Name of Business: <br />Contact Person: _a <br />Physical Address: <br />Mailing Address: <br />DESCRIPTION <br />Type of <br />Volume: <br />Chemica <br />Circumstances: lDr2A � iF cL4=—: <br />USINESS <br />Telephone: (_) <br />EH 22 013 (Rev.4/91) <br />