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C. <br />10 <br />SAN JOAQUIN COUNTY --� <br />NOTIFICATION OF HAZARDOUS BASTE DISCHARGE <br />HEALTH & SAFETY CODE 25180.7 <br />EMERGENCY LEVEL: I II III <br />PHS -EH LOG <br />( rcle One) <br />SOURCE OF INFORMATION Phone: <br />Name: T�1'e5 o <br />Company: C,. qp OZ- 6038 <br />Address: 6003' <br />Phone: (_) - <br />Desigrated Employee Name: <br />Reporting Agency Name: <br />Address: <br />LOCATION AND DATE �Ud I:Location: e E <br />(Best Physical Descri <br />Date of Discharge: <br />Date Notified: <br />RESPONSIBLE PERSO <br />Name of Business: <br />Contact Person: —11 <br />Physical Address: l' <br />Mailing Address: <br />(City r County) Circle One <br />Time: 0 , DO <br />DESCRIPTION ve— <br />Type <br />Volume:u� <br />i 1f • 1 <br />Lr <br />F. ACTION TAKEN_11,1,11 <br />D[SPFOSITI <br />EH 22 013 (Rev.4/91) <br />