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SAN JOAQUIN COUNTY �' <br /> NOTIFr�iTION OF HAZARDOUS WASTE D 1�--HARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II <br /> PHS-EH LOG #_ <br /> cle Ore)-- <br /> B. SOURCE OF INFORMATION l <br /> Name: P,orG /-I- 60 <br /> Company:__--`? PLid .y, � Phone: <br /> Address: CoZ Ict Zvi I <br /> Designated Employee Name: <br /> Reporting Agency Name: Phone: (_) <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location:_ fi- <br /> (Best Physical Description) <br /> Date of Discharge: 6,(,-n k�rL6?,L-y? City' r County) Circle One <br /> Date Notified: , --/2 71 Z <br /> Time: // <br /> D. RESPONSIBLE PERSOWBUSINESS <br /> Name of Business: / 2 n pS 0 <br /> Contact Person: <br /> /L Telephone: ( ) <br /> Physical Address• � Z l o v�/ ,4 7 o / <br /> Mailing Address 5 ovrn-q_ � <br /> E. DESCRIPTION <br /> Type of Discharge: //,iii T <br /> Volume: , <br /> Chemicals: <br /> Circumstances: If7 <br /> F. ACTION TAKEN a <br /> EH 22 013 (Rev.4/91) <br />