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� SAN .iOAQUIN COUNTY <br /> N0TIFIZ!: T ION OF HAZ.,�PDOUS WASTE D[ URGE <br /> HEALTH & SAFE-1,Y CODE 25180.7 <br /> . ,. <br /> � 1- � <br /> 3 0 <br /> EMERGrNCY LEVET . I II IPHS-EH LOG <br /> (Circle One) <br /> 3. SOURCE OF INFORMATION <br /> Name: Phone: �) <br /> Company: a <br /> Address: 3o -�So 11-z 4SO.Cjn,�rrv- y- CA <br /> Designated Employee Name: Phone: L� <br /> Reporting Agency Name: <br /> Address: off _ w 4n Fn_ AilL <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: F- <br /> (Best Physical Destiipdon) Ci or County) Circle One <br /> Date of Discharge: <br /> Date Notified: T c <br /> D. RESPONSIBLE PRRS USINESS d <br /> Name of Business: LA1�1 <br /> Contact Person: Telephone: (244) A5g G21x� <br /> Physical Address: <br /> mailin; Address: 46 j4;6,s4 -.12 6 L LE/Uie .¢ 53� <br /> DESCRIP'T'ION <br /> Type of Discharge: <br /> Volume: 1-,gAj AL <br /> Ch e_*nicals: Ael <br /> Circumstances: <br /> ,4 ay <br /> F. ACTION TAKEN <br /> SiTE STATUS aw ,Z <br /> -- 2.2013 (Rev-4i91) <br />