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SAN JOAQUIN COUNTY �� V <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHABCZ <br /> HEALTH & SAFETY CODE 25180.7 COPY <br /> A. EMERGENCY LEVEL II II III PHS-EH LOG # <br /> (C�rcle One) <br /> B. SOURCE OF INFORMATION <br /> Name: 4Da.r\ 1'Yl..a e- Phone: 4?2EJ) Ian-,.3 v:;,,b <br /> Company: <br /> Address: 4�JS SY2 ,r� <br /> Designated Employee Name: ryl Phone: e�2) q6,?-3 <br /> Reporting Agency Name: Q <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: I O O 0 `, �e-,j / <br /> (Best Physical Description) (City OH"un One <br /> Date of Discharge: <br /> Date Notified: I to a Time: 3 `•0 rn <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: I, r C LA L),-- <br /> Contact <br /> eContact Person: el hone: L� <br /> Physical Address: I o 0 o (� y fliw- <br /> Mailing Address: i' b I y -56-7 <br /> E. DESCRIPTION LCe �L <br /> Type of Discharge: <br /> Volume: I L V. b�Jv� urs <br /> Chemicals: cL�earl <br /> Circumstances: I , <br /> F. ACTION TAKEN <br /> SITE STATUS LA <br /> U <br /> EH 22 013 (Rev-4/91) <br />