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SAN JOAQUIN COUNTY • <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 C 0 [PY <br /> A. EMERGENCY LEVEL: � I II III PHS-EH LOG <br /> (C"Ycle One) <br /> B. SOURCE OF INFORMATION <br /> Name: hl<?� ( i ✓ fcti�'[L YNS�FfM Phone: 2�r yC- f yyL <br /> Company: <br /> Address: <br /> Designated Employee Name: Phone: L� <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE qF DISCHARGE <br /> Location: 2C1?N 641 L/A i fir . 14U / 5L,� <br /> (Best Physical Description) Cityvor County) Circle One <br /> Date of Discharge: k <br /> Date Notified: 3Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: U.$.. <br /> Contact Person: (� j� n ('t Telephone: (22o <br /> Physical Address: S fob <br /> Mailing Address: /,C, (3pX So(5q R� ry CA Ogvy <br /> E. DESCRIPTION <br /> Type of Discharge: L!.�, 144 az 11- <br /> volume: <br /> Chemicals: <br /> Circumstance <br /> F. ACTION TAKEN Z(J SSt�P�Qu�C �� <br /> SITE STATUS 1., <br /> EH 22 013 (Rev.4/91) <br />