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a-10/-1997 1 :27PM F%� 1, _ P- 3 <br /> SAN JOAQUIN COUNTY APR - 7 1997 <br /> .' NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 - - <br /> -,� SAN JOAQUIOUM'! <br /> N C <br /> OFFICE OF EMERGENCY SERJi"" <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG # q�'04 <br /> (CI"rcle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Phone: C_ ) <br /> Company. <br /> Address: <br /> Designated Employee Name: Phone: (r_-) <br /> Reporting Agency Name: <br /> Address;3 4* e5 _p� <br /> C. LOCATION AND DATE OF DGE <br /> Location: _ } /Jn. <br /> (Best Physical Description) r 9 Circle One <br /> Date of Discharge: die—, dry . <br /> Date Notified: =9 :7 Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: <br /> Contact Person: Telephone: Cada) 4. a' -93¢ z-- <br /> Physical <br /> Physical Address: <br /> Mailing Address. <br /> E. DESCRIPTION <br /> Type of Discharge: S� s SaQ Jwt o` r . <br /> _ volume: d"k4,,Sti <br /> Chemicals: 62o"-- s 14 r, t� a`rd A el) . <br /> Circumstances: <br /> F. ACTION TAKEN ZAXt2 (&AJ <br /> SITE STATUS <br /> EH 22 013 (Rev.4/91) <br /> RPR-07-1997 14:32 95% P.03 <br />