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A. <br />E <br />SAN JOAQUIN COUNTY <br />NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br />HEALTH & SAFETY CODE 25180.7 <br />EMERGENCY LEVEL:11 III <br />(Circle One) <br />SOURCE OF INFORMATION <br />nr•,..,o• 77A L T -r-- 1 Ko <br />Company: o <br />Address: o >C <br />Designated Employee Name: <br />Reporting Agency N e:_ <br />Address: <br />C. LOCATION ANP DATE�F <br />Location: <br />(Best Physical De <br />Date of Discharge: U <br />Date Notified: o <br />D. RESPONSIBLE PEI <br />Name of Business: <br />Contact Person: _ <br />Physical Address:. <br />Mailing Address: _ <br />E. DESCRIPTION <br />Type of Dischz <br />Volume: Us <br />Chemicals: <br />r ACTION T. <br />J <br />E <br />PHS -EH LOG # �— %9l <br />Phone: <br />Phone: <br />(1:23�br County) Circle One <br />Time: ////��4. r <br />Telephone:] - <br />70 <br />SITE DISPOSITION <br />y i %E �'� i� f� ✓rte'-'^ <br />EH 22 013 (Rev.4/91) <br />