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%1.t IF.1_e <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE r <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I ti III <br /> PHS-EH LOG / ' - T 3 b <br /> (Circle One) <br /> B. SOURCE OF INFORMATION Phone: sLO) z/o 7- Z6oq <br /> Name: --7- 13.e2L� or(`r' <br /> Company: D 9o7oz - <br /> Address: <br /> Designated Employee Name: Phone. (_) <br /> Reporting Agen�y Name: FAQ vS7 ' <br /> Address: S�c c 1cTb�/ <br /> C. LOCATION AND DATE OF DISCHARGE sqf/ sdAe �1 <br /> Location: /�?7T� �� 511 * 1-7) / ,rcle One <br /> (Best Physical Descripti n) ((Cityo"'U <br /> Date of Discharge: o Z l r Z-- <br /> 1. <br /> Date Notified: Time: 9 ' no %"4 <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: &-E? Tele hone: .5'o 40 7 <br /> Contact Person: i �� "`� o,�' P <br /> Physical Address: Zo 1 <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: G <br /> Chemicals: <br /> Circumstances: rrT'/ <br /> F ACTION TARN <br /> s�Fr� r Docvi�J S,o�G�ZY� �4S w.9S cold ^J� ro Ti�E <br /> SITE D(SPOS[T[ON �f3So=B.4 �A� <br /> X <br /> EH 22 013 (Rev.4/91) <br />