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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVELID[[ III <br /> PHS-EH LOG 194 <br /> (Circle One) <br /> B. SOURCE OF INFORMATION Phone: S!o c(o7—Z-60 <br /> Name: S 00 <br /> Company: X7'070 <br /> Address: Phone: Lj <br /> Designated Employee Name: <br /> Reporting Agency N e: Glc c c7SZv <br /> Address: yyS 214 <br /> C. LOCATION AND DATE OF DISCHARGE z— <br /> Location: 49;/' 1 -- l / ((�r County) Circle One <br /> (Best Physical De rip q) <br /> Date of Discharge: <br /> Date Notified: 2 Time: <br /> D. RESPONSIBLE PERSO BUSINESS <br /> Name of Business: Telephone: Yo v ? D 3 <br /> Contact Person: Al 7 p <br /> Physical Address: G o <br /> Mailing Address: <br /> E. DESCRIPTION A <br /> Type of Disch e: <br /> Volume: GGA <br /> Chemicals: <br /> Circumstances: <br /> JE o�F i <br /> F. ACTION TAKEN //A(4401V'J <br /> SITE DISPOSITION -Jlyo' TUY� <br /> EH 22 013 (Rev.4/91) <br />