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SAN JOAQUIN COUNTY py <br /> NOTIFICATION OF HAZARDOUS WASTE DxQ <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I 'II III PHS-EH LOG 03—0.30 <br /> (Circle one) <br /> B. SOURCE OF INFORMATION <br /> Name: S w'r(a" Phone: <br /> Company: <br /> Address: 14 Z4 cA - Aaw...ar_ .,fie K. s.Jitiy N-aK k. r—*- 4 l-733 <br /> Designated Employee Phone: <br /> Reporting Agency Name: -'L- Sa.c <br /> S 1ae.11l. wal!--* <br /> Address: 304 -L4-LAv M& <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: -1 0 S <br /> (Best Physical Desc don) Ci or County) Circle one <br /> Date of Discharge: V A- ;,.-- <br /> Date Notified: . 0.1.1AD3 _ Time: 4=30A-%,_ <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: a e:s .Q _ <br /> Contact Person: Phone: jr - <br /> Physical Address: S&I h l o. ° <br /> Mailing Address: <br /> E. DESCRIP'T'ION <br /> Type of Disc.. <br /> Volume: <br /> Chemicals: <br /> Circumstances:.Circumstances: �r►,..IG�-�.��- <br /> F. ACTION TAKEN C'utyd�ur <br /> SITE DISPOSITION "TO d#4sr n u r60-j <br /> EH 22 013 (Rev-08120/98) <br />