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SAN JOAQUIN COUNTY p� <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGr <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL II III PHS-EH LOG # <br /> ( ircle One) <br /> B. SOURCE OF INFORMATION ,��� <br /> Name: Q? Phone: (,20 e 'b� 7337 <br /> Company: <br /> Address: DO _ <br /> Designated Employee Name: /-at( �,` U , r i o rr s Phone: <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE �i <br /> Location: /00(-) 2SAS -r �' 6c cv`c / �7�G/ 1 �0, - <br /> (Best Physical Description) (City r County) Circle One <br /> Date of Discharge: ✓n�t-(/�J <br /> Date Notified: < r— // — 9 Time: 7O <br /> D. RESPONSIBLE PERSON/BUSI ESS <br /> Name of Business: CJI G , <br /> Contact Person: Telepho : �? !q`}�—7 3 7 <br /> Physical Address: e- S 4 O <br /> Mailing Address: �biYn_e_ <br /> E. DESCRIPTION A' <br /> Type of Discharge: 6�/,�Y12� a S7— <br /> Volume: C <br /> Cherr icals: <br /> Circumstances: - <br /> F. A ON TAKEN <br /> v <br /> �l�9 <br /> L n� a� <br /> SITE STATUS <br /> �2 <br /> i <br /> EH 22 013 (Rev.4/91) <br />