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r <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVELhII III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Phone: 202 <br /> Company: 4Z,, <br /> Address: 3 - <br /> Designated Employee Name: Phone: 20qq6,r--- 3 Li� <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: <br /> (Best Physical Description) ity r County) Circle One <br /> Date of Discharge: <br /> Date Notified: !9,2— Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: l/� 7 <br /> Contact Person: 17? Telephone: Ud s� c. <br /> Physical Address: <br /> Mailing Address: C,,aLiA /(J� ��k17 9 <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: c� E.: o..�r u ^� I�-4211 <br /> Chemicals: / G so�/ c% u�►l�Kow.+ ` "¢' <br /> Circumstances: .�-. / ��s u/clo z <br /> F. ACTION TAKEN A 2yt eni,1 f � f.a tv�.�r I� .f�.� 4n t/w I– EiPA <br /> SITE DISPOSITION�v, k • - s v</ i S �'�- %��� �`^ /GAG r ���• <br /> Al G! r��2��1 <br /> f, Aze �'DL �,//yIQG/ r� ��/+G✓i�r.cip�/ /?.L YGLt� /!�7/('_ �/ T�// <br /> O <br /> EH 22 013 (Rev.4/91) <br />