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r.r <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> PHS-EH LOG #—L - <br /> A. EMERGENCY LEVEL( ircle One) <br /> B. SOURCE OF INFORMATION Phone: (_) <br /> Name: <br /> Company- <br /> rF" V r - 3Address: hone ` «` `: <br /> Designated Employee Name: <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE / S bDC_k�„ <br /> Location: Sr`15 C C <br /> (Best Physical Description) (City or County) Circle One <br /> Date of Discharge: ,q`/ /- <br /> Date Notified: /c^/-5 Time: //' <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: !J Ljfl S <br /> Contact Person: Telephone: (]ffl� y6 Y- Gob G <br /> Physical Address: 9 -/!S-- <br /> Mailing <br /> /SMailing Address: S�� i * 1576 <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: b G a (1r)'n <br /> Chemicals: L > G s Ike, <br /> Circumstances: /, 55-:z./ <br /> F. ACTION TAKEN 7;;Fe <br /> /O /Y S� � O 3 i✓/v CJ /�rtyo0 �!c <br /> SO on�✓ /2�f S q.r/1O/I S �- �4sYr or <br /> ,•„ 76re / 4,4 <br /> --4-A T <br /> SITE DISPOSITION�j <br /> cam. � •/� w'4' c /•�Jn�i xr�/ - - I -- <br /> EH 22 013 (Rev.4/91) <br />