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06/10/2003 15:37 2094b83433 FIFTH FLOOR PAGE 02 <br /> PEC EV77D <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISC1JA12GE JUN 18 2003 <br /> HEALTH & SAFETY CODE 25180.7 <br /> —� MCECi CViER1GEN+;, a'ER <br /> - VICE <br /> A. EMERGENCY LEVEL: I II III PHS-FH LOG K <br /> (Circle one) <br /> B. SOURCE OF INFORMATION <br /> Name: Phone: { ) <br /> Company: <br /> Address: <br /> Designated Employee Name: Phone: <br /> Reporting Agency Name: „r Sve.c�w J v ti•rL_ <br /> Address: <br /> C. LOCATION AND DATE OF DISCKARGE <br /> Location �7gaSi(JJ <br /> (Best Physic 1 Desc tion) (City or oun , Circle one <br /> Date of Discharge: / I 1`} o <br /> Date Notified: t -- Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: <br /> Contact Person: Phone: <br /> Physical Address: <br /> Mailing Address: l <br /> E. DESCRIPTION <br /> ' Type of Disch'arge:_Ma&15; �_ <br /> Volume <br /> Chemicals: <br /> Circumstances: tM <br /> F. ACTION TAKEN fie. <br /> SITE DISPOSITION G - <br /> - <br /> 1 <br /> EH 22 013(Rev. 09120198) <br />