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2-03-1999 Q=39PM rRUM <br /> Ir <br /> EOFFIrE <br /> SAN JOAQUIN COUNTYF® _ 3m �NOTIFICATION OF HAZARDOUS WASTE DISCr1ARGEHEALTH & SAFETY CODE 25180.7 <br /> OFEG'4T(s;.jy!�- Fil, ,_CL ) <br /> A. EMERGENCY LEVEL: I a III PHS-EH LOG # / q, <br /> (Circle One) <br /> B. SOURCE OF INFORMA N <br /> Name: C Phone: <br /> Company: <br /> Address: <br /> Designated Employee Name: rp' 2 ff Phone: fir ) 6� 3YS9 <br /> Reporting Agency Name: <br /> Address: 36 S/ L !/rPl.� yi Sfo C'at 9rLCf <br /> C. LOCATION AND DATE OF DISCHARGE Js <br /> Location: Prn�l T f rfU 59 / <br /> (Best Physical prion) Ci r County) Circle One <br /> Date of Discharge: <br /> Date Notified: a-, t f 1 Time:_ /'n 7w <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: (JIz?0-zLr <br /> Contact Person: �Telephone: <br /> I Physical Address- �� I GS « � �' `d <br /> Mailing Address: (� P►+! P �'/ T fid' <br /> DESCRIPTION - f� <br /> Type of Discharge: ._ <br /> Volume: l/ <br /> Chemicals: r <br /> Circumstances. <br /> F. ACTION TAKEN <br /> lee <br /> SITE STATUS / Z2 <br /> EH 22 013 (Rev.4/91) <br />