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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 251.80.7 <br /> A. ENIERGENCY LEVEL(D II III PHS-EH LOG R Q <br /> (Circle one) <br /> B. SOURCE OF INFORM,%TION° <br /> Name [/ P Phone: (I_993 �ggg <br /> Company5 j <br /> Address:Al <br /> Designated Employee Name: -AL D Phone: $- <br /> Reporting Agenc} Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> �- � a <br /> Location: Z w i i r County) Circle one <br /> (Best Physical Description) <br /> Date of Discharger Time: $'.?:)Q6 /1 <br /> Date Notified: i <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: Ll_2GZ phone: - <br /> Contact Person: a <br /> Phvsical Address: 1'0 <br /> Maiiing Address: <br /> wtjP- <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: L 1 <br /> Chemicals:-KQA <br /> 2 <br /> Circumstances: Y' <br /> y� <br /> F. ACTION TAKENL-TaA*S <br /> 12 fi <br /> SITE DISPOSITION r �`V <br /> EH 22 013 (Rev. 08120198) <br />