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i <br /> SAN JOAQULN COUNTY <br /> D NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> } HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: II III EH LOG-9 �n� —COLI S <br /> ircle one) <br /> B. SOURCE OF INFORNIATION <br /> Name: l <br /> Phone: V-VI) <br /> Company: C <br /> Address: `] —' phone: <br /> Designated Employee Name: <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: arJ� C� e .0 o <br /> (Best Physical Description) {City or County) Circle one <br /> Date of Discharg : Time: <br /> Date Notified: l az <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: VAb n F� phos <br /> Contact Person: 10, <br /> Physical Address: d "' �. [,0 95670 <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: <br /> Chemicals: t <br /> Circumstances: <br /> F. ACTIO TAKEN <br /> SITE DISPOS ION <br /> EH 22 013 (Rev. 08!20198) <br />