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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVE(COiir <br /> II III PHS-EH LOG # <br /> leOne) <br /> B. SOURCE O FO <br /> Name: " =�" Phone: (�t Z 3�` d�"!C>- <br /> Company: T <br /> Address: 15w <br /> Designated Employee Name: Phone: �) <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: �v�l� Al C' 16- zm <Y. / � ,✓ <br /> (Best Physical Description) Ci r County) Circle One <br /> Date of Discharge: <br /> Date Notified: /0— 0 S Time: <br /> D. RESPONSIBLE PERSON/B SINESS <br /> Name of Business: .S '' i2 L"� <br /> Contact Person: elephone: (_ –4 OZ_ <br /> Physical Address: Sy 5 �- <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: <br /> Chemicals: <br /> Circuniptances: f - <br /> F. ACTION TAKEN <br /> SITE DISPOSITION_ dam- �'lZ <br /> --�-► /Jdc-Cb TS C <br /> 47 4C" <br /> EH 22 013 (Rev.4/91) <br />