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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 FILE COPY <br /> I II PHS-EH LOG T q9 • 055 <br /> A. EMERGENCY ( III Circle One) <br /> B. SOURCE OF INFORMAL phone: 20`! Yl�dr-3Y�( <br /> Name: /17 [�b <br /> Company: <br /> Address: Phone: <br /> Designated Employee Njj <br /> ame: <br /> Reporting Agency Name: SZ-2 <br /> S <br /> Address: Z `I F, e <br /> C. LOCATION AND DATE OF DISCHARGE �y� c / <br /> Location. 3 S S W ' C' (City Counr Circ'-e One <br /> (Best physical Description) <br /> Date of Discharge: ^ /c" <br /> Date Notified: <br /> D. RESPONSIBLE PERSON/BUSINESS / <br /> a r //c✓ �yc - 93(0 <br /> Name of Business: Telephone: CLO--,---- <br /> Contact Person: 3 ssO`X)f <br /> physical Address: . <br /> Mailing Address: 0 , Bo,c 9yd <br /> E. DESCRIPTION - f <br /> Type of Discharge: <br /> volume: // <br /> Chemicals: -j::14 <br /> lances: r` � <br /> Xr � <br /> F ACTION TAKEN Placecir <br /> ` UA <br /> SI FE STATUS � s <br /> EH 22 013 (Rev-4/91) <br />