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' SAN JOAQULN COU`ITY <br /> YO=CATIOLNI OF HAZARDOUS WASTE DISc'3-A . E COPY o P Y <br /> gL-sLTH & SAFETY CODE 2^130.7 � �IL r <br /> A. EMERGENCY LEVEL:C� II III PSIS-E-I LOG <br /> (Circle one) <br /> B. SOURCE OFINFOILMATION <br /> Name: n C I C.�e C�Cdvr� Phone: (2 61 TLa 3 - 17 1le <br /> Company: <br /> Address: <br /> Designated Emplovee Name: Phone: d <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCH.aRGE i <br /> Location:c� v E +"� �'� <br /> (Best Physicai Description) (City or Q2_nD Circle one <br /> Date of Discharge: 3 q 99 <br /> Dare Notified. -'R 9 9 9 T me: <br /> D. RESPONSIBLE PERSON/BGS IIYESS <br /> Name or Business: <br /> ContactPerson: Phone: a a 4 3--7Phcsical Address: S <br /> Mailing Address: ' <br /> E. DESCRIPTION <br /> Type ofDisciiarge: <br /> Volume:-* <br /> Cpemicals: <br /> Circumstances_ <br /> V <br /> AC N TAKEN <br /> F. <br /> 41 v <br /> SITE PISPOSmON <br /> EH 22 013 lRev.08;2-0/93) <br />