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• SAN JOAQUIN COUNTY to <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVE II [[I PHS-EH LOG # <br /> ircle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Phone: <br /> Company: <br /> Address: <br /> Designated Employee Name: i T11 D Phone: �//oB-033 <br /> Reporting Agencyy Name: ff5 - EH <br /> Address: `fy5 2r7, oa�u�✓ �fipa �fijTq�d�1y� <br /> C. LOCATION AND Al OF ISI, dzi6n <br /> Location: ��ff JI�2� � <br /> (Best Physical Description) Cir County) Circle One <br /> Date of Discharge: 46i ,L D YJrt <br /> Date Notified: 11-12--qy Time:_ 8 :00 q-m <br /> D. RESPONSIBLE PERSN/BUSINESS <br /> Name of Business: <br /> Contact Person: rnQa_L Telephone: QM -(0 3 <br /> Physical Address: <br /> Mailing Address: zu 31 W. Admnh LX ` b .� g —ZD <br /> E. DESCRIPTION <br /> Type of Discharge: _ �eQ �< <br /> Volume: <br /> Chemicals: G(>Q / 50/l/�m <br /> Circumstances: el �7 na I _ O ¢ <br /> 3 UST" re�w.or�.9-s . <br /> F. ACTION TAKEN fi/1 r1{L YPiw,TSS,O S S gyral,o, r� 1 �AA(4 0 <br /> SATE DISPOSITION S <br /> EH 22 013 (Rev.4/91) <br />