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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> COP <br /> HEALTH & SAFETY CODE 25180.7 � <br /> A. EMERGENCY LEVEL: PII III PHS-EH LOG 0/3 <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Phone: C�'b) <br /> Company. <br /> Address: �D �x S �r7i ?0 70 Z- <br /> - 3 8 <br /> Designated Employee Name: Phone: (_) <br /> Reporting Agency Name: <br /> Address: nl- 5AA) 7z;�44--r/Q s sic gra ( �SZc / <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: <br /> (Best Physical Dq�scripon) (City oma n—�) Circle One <br /> Date of Discharge: //25/ T 3 <br /> Date Notified: Z / 9 f2 Time: 30 G <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: /QGy <br /> Contact Person: Telephone: 3(7) 5G7-zZ41��- <br /> Physical Address: <br /> Mailing Address: o77z — 3 <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: Lyv�O <br /> Chemicals: ��—��/� <br /> CircurFutances: 14AlEo <br /> F. ACTION TAKEN <br /> :V-7— <br /> SITE DISPOSITION <br /> EH 22 013 (Rev.4/91) <br />