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SAN JOAQUIN COUNTY `- �� E COPY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHAR <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG k O — Oa--) <br /> (Circle one) <br /> B. SOURCE OF INFORMATION <br /> Name: CATA I j Phone:,Qq <br /> Company: Yf <br /> Address: <br /> Designated Employee Name: Phone: A 0 co <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE C� <br /> Location: 119 9 g ) <br /> (Best Ph sical Description) Q ` City o ounty) Circle one <br /> Date of Discharge: y !7— /7 / <br /> Date Notified: 9— �— D ( Time: <br /> D. RESPONSIBLE PERSOWBUSINESS <br /> Name of Business: TI <br /> Contact Person: S Phone: a0 - ' <br /> Phvsical Address: <br /> Mailing Address: S" 0 C r <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: <br /> Chemicals: <br /> Circumstances: <br /> 67 V <br /> F. ACTION TAKEN <br /> 97 <br /> SITE DISPOSITION Jlz2A, <br /> e <br /> EH 22 013 (Rev. 08/20/98) <br />