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z <br /> SAN JOAQUIN COUNTY "NNW <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE f� <br /> HEALTH & SAFETY CODE 25180.7 <br /> U <br /> A. EMERGENCY LEVEL:3 II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: //,"// Phone:Phone: z± <br /> Company:_ h e7rav c{,;z ���2 t.cif l/�All-If 'rr-3 G� <br /> Address: CY <br /> Designated Employee Name: Phone: (`o 9) 'Y C 6 3� <br /> Reporting Agency Name: : <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: /O4/ T,r Zr <x % / <br /> (Best Physical Description) City r County) Circle One <br /> Date of Discharge: <br /> Date Notified: - Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: G. 7- <br /> Contact Person: r- Telephone: (Lo2) 9 yF- <br /> Physical Address: <br /> Mailing Address: /",2, -60,x' G' •���, �o�� G.� 1.S-•21* d l <br /> E. DESCRIPTION <br /> Type of Discharge: O%� 64,5i-)1227 (f- <br /> Volume: <br /> Volume: 6 vt <br /> Chemicals: / &-- <br /> Circumstances: c•��c� D eo��i� ce✓tL� oz� <br /> F. ACTION TAKEN ocJ <br /> x-/._ <br /> ry 14 z vi <br /> �c <br /> SITE STATUS <br /> EH 22 013 (Rev.4/91) <br />