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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGED nr <br /> HEALTH & SAFETY CODE 25180.7 ()// <br /> A. EMERGENCY LEVEL: T'II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Phone: <br /> Company: <br /> Address: &oil 64d/( , /dae�ESs yl�� q o 7 0 2 —G e�z/ <br /> Designated Employee Name: Phone: (� ' <br /> Reporting Agency Name: <br /> Address: /J• SoA ST- r /clg� <br /> C. LOCATION AND DATE OF DISCHARGE L <br /> Location: /gam 7b Gflcvc� �y9C�Q C.Eic�7 U 21' / S4rl �'4a c �f <br /> (Best Physical D?gscri,gtion) (City or oun Circle One <br /> Date of Discharge: ///5/ -7 zi <br /> Date Notified: / Lsl ?2 Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: Al—r14 �56b <br /> Contact Person: iIi rT ��_ Telephone: <br /> Physical Address: 1 7t� �ocv �2_ �agc�Aft - 7bl�lSjJ <br /> Mailing Address: � '�• c�olC ���/ i . ,Ff �/� _�p7o2 6�f <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: <br /> Chemicals: <br /> Circumstances: i E <br /> F. ACTION TAKEN <br /> SITE DISPOSITION <br /> EH 22 013 (Rev.4/91) Q <br />