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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <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: Phone: C�- Yb� 335 7 <br /> Company: r, „ „ L. /dam, Sah moa Co <br /> Address �3 C. ��a /=er uo��cfz Co <br /> Designated Employee Name: ( c ,t / o Phone: Zee jk -3v-ra <br /> Reporting Agency Name: .,3 c P/fs <br /> Address: V Y s ti, S C- <br /> C. <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: d V S. N&,,, Je-, S <br /> (Best Physical Description) City or County) Circle One <br /> Date of Discharge: L. /6-h <br /> Date Notified: S-/1=9.a-- Time: 4D. RESPONSIBLE PERSON/BUSINESS /' <br /> Name of Business: G,2df , �3/�� /'C,? /,s i3/ply <br /> Contact Person: i?P r Gr r<i s o-, ” Telephone: (ZED ee,- -33 s� <br /> Physical Address: / .P9 Scoffs, Stf�. rw - rszaf <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: ze <br /> Volume: I.,�Ie- <br /> Chemicals: y,Ps P/ <br /> Circumstances:_ acs., {mss/ , iy?0 <br /> F. ACTION TAKEN_ 7/- ,/r <br /> SITE DISPOSITION <br /> Wil. . aAr ex-h'--f o <br /> EH 22 013 (Rev.4/91) <br />