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SAN JOAQUIN COUNTY <br /> NOTIFICA:`ON OF HAZARDOUS WASTE DISCHARG <br /> HEALTH & SAFETY CODE 25180.7 O <br /> A. EMERGENCY LEVEL I II -7 PHS-EH LOG 4 <br /> acle One) <br /> B. SOURCE OF INFORMATION San _S <br /> �V '� �� Phone: <br /> Name: /C <br /> Company: - nil1 .., <br /> Address: <br /> Designated Employee Name: Phone. <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISC GrE / <br /> Location:— <br /> (Best Physical Description) City r County) Circle One <br /> Date of Discharge: LA vt <br /> Date Notified: �?�t = / `�`�� Time: �l 30cc-h, <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: <<-' L 1-L <br /> Contact Person: �b -� LON/— Tel phone: /Z <br /> Physical Address: 3 a �) -7 SOY ��`� Ub1 S 5 3 <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: ,' <br /> Chemicals: ►� <br /> Circumstances: f' Lx <br /> F. ACTION TAKEN Gj,(ODV�, 2/27 � <br /> SITESTATUS I-z U "' < u�/� �Y1 L-a&C <br /> EH 22 013 (Rev.4/91) <br />