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SAN JOAQUIN COUNTY NOTIFICATION OF HAZARDOUS WASTE DISCHARGE Copy <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: <br /> Phone: <br /> Company: r —ro� •i L� <br /> Address:TI.sRn <br /> Designated Employee Name: Phone: C_) <br /> Reporting Agency Name: <br /> Address: y5L.S— <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 25lb W l TM S+ <br /> (Best Physical Description) (City or County) Circle One <br /> Date of Discharge: i_ 2p _ 16 <br /> Date Notified: i- ago- 9 e Time: WP ren-, <br /> u <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: --rQ a r� - c—Q ti • � , <br /> Contact Person: rif, c „4 "ne-6 Telephone: C__) <br /> Physical Address: t,J I�S� <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: $S- <br /> Volume: l <br /> Chemicals: <br /> Circumstances: <br /> F. ACTION TAKEN <br /> SITE STATUS <br /> EH 22 013 (Rev.4/91) <br />