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SaN JOAQUI`i COU`'Ty <br /> �iOTIFICATIOv OF HAZARDOUS, WASTE DISCHARGE EIL E COPY <br /> HE-kLTH & SAFETY CODE 25130.7 <br /> A. E'NIERGENCY LEVEL:OII III <br /> PHS-EH LOG T <br /> (Circ:.- one) <br /> B. Sot-RCE OF INFORNNIATIOiiN <br /> Phone: ( ) <br /> Name: c �" <br /> Company: <br /> :address: <br /> Phone: ?�Y <br /> Designated Emptover Name: V <br /> Reporting Azency Name. <br /> Address: <br /> ' <br /> C. LOCATION DATE OF DISCH.kRGE <br /> Location: ( or County) Circle one <br /> (Best Phvsicai Description) <br /> Date of Discharge: � <br /> Time: <br /> Date Notified: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: t-�-r C- ti'1 r p <br /> Phone: <br /> Contact Person: C JA, U �: <br /> P!lysical .address: Li <br /> Mailing .address: ' I <br /> E. DESCRIPTION , <br /> T -De or Discharge: <br /> rLl <br /> Voiume: �� L <br /> Clemicals:_��y� t �'Z� tln o !ro �l c ✓ <br /> C irc unstan v <br /> F. ACTION TAKEN <br /> r <br /> 74 t <br /> A.;e--C <br /> SITE DISPOSITION <br /> EH 22 0 t 3 1 Rei•. <br />