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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE C(apy <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:OI II III PHS-EH LOG # 17 5,� <br /> (Circle One) <br /> B. SOURCE OF INFORMATION Phone: <br /> Name: <br /> Company: eb�cv <br /> Address: <br /> Designated Employee Name: Phone: <br /> Reporting Agency Name- <br /> Address: _QA,\ �csy4CJ17ra s- S7c7c� � g�2o/ <br /> C. LOCATION AND DATE OF DISCHARGE GoQ= <br /> Location: /997a �r County) Circle One <br /> (Best Physical Des", <br /> 'ption) <br /> Date of Discharge: 9 <br /> Date Notified: Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: -A <br /> Contact Person: _ iG� ZAl�/G�- Telephone: L14 670- 15-/04 <br /> Physical Address: <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: G / <br /> Chemicals: �a <br /> Circumstances: L77-/ <br /> F. ACTION TAKEN <br /> EH 22 013 (Rev.4/91) <br />