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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG # L10 <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: kP f7-S Phone: <br /> Company: <br /> Address: <br /> Designated Employee Name: Lo 4-i 1--)'n P)r i nS Phone: — <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE e <br /> Location: EZZ -FRAC (/ C- <br /> (Best Physical Descri tion) (n�pr Co ty) Circle One <br /> Date of Discharge: <br /> Date Notified: I%—1 - 9 Time: . GCn W, <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: C-/ P. S. �- <br /> Contact Person: •S Telephone: (ILD) Q � - GGA <br /> Physical Address: <r 1 C <br /> Mailing Address: O <br /> E. DESCRIPTION � n <br /> Type of Discharge: tin.ao:i-27 4' /'(Lb0-,-J P "6a A —v LC G S T <br /> Volume: v� C <br /> Chemicals: <br /> Circumstances: <br /> M, <br /> F. ACTION TAKEN <br /> A S moi-• - <br /> SITE DISPOSITION c C r a <br /> r e 424-411- <br /> - <br /> EH 22 013 (Rev.4/91) <br />