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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH &71 SAFETY CODE 25180.7 <br /> A. EMERGENCY LZv'EL: It;I1 III ; 1 J:11Q , ' EH LOG # <br /> � <br /> ( rcle One) <br /> B. SOURCE OF INFORMATION <br /> Name: �-r F oto Phone: (7�1, } <br /> Company:��E - <br /> Address: <br /> Designated Employee Name: Phone: [�' <br /> Reporting Agency Naive: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: s <br /> (Best Physical Description) ��r� oun ' cle One <br /> Date of Discharge: <br /> Date Notified: / ; 4 Time: /t = 7a <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: r l-"r6 0/211 <br /> Contact Person: -r-r�!•�# yet /�v/�-_�'� Telephone: <br /> Physical Address: „-Z 7 7 <br /> Mailing Address: °� y 7_ s,6, <br /> E. DESCRIPTION <br /> Type of Discharge: lint F. fHt�zE, <br /> Volume: r l4zivaw <br /> Chemicals: 6A�c-rNE <br /> Circumstances: <br /> So tG CDN i�i'�rN•�-T��.,J __ .. <br /> F. ACTION TAKEN <br /> SITE DISPOSITION <br /> .di'�-T6"� �ySf�� /��Ti`dE� �'r?Gyr�!yES7i6�77dr✓/��`i' .,�� �'E!v��°��— <br /> EH 22 013 (Rev.4/91) cJ A 0 <br />