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t s <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:M II III PHS-EH LOG 4 <br /> (Circle one) <br /> B. SOURCE OF INFORMATION <br /> Name: ��/,� F_) _ Phone: (f'1S} 37v 3q q <br /> Company: <br /> Address: . 9 S5 3- CS <br /> Designated Employee Name: Phone: <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: (b�$ �u_t jZo I f�i <br /> (Best P41v ical Description) (City or Countv) Circle one <br /> Date of Discharge: <br /> Date Notified: C3 tq`t g Time: (l:Dot .,�- <br /> D. RESPONSIBLE PERSONIBUSINESS <br /> Name of Business: 7- T^c/ <br /> Contact Person: C3ab- Yt L M/^_0 <br /> Phone: 50 Z <br /> Physical Address: <br /> ivlailine Address: [b2?-o S.w• _C2AL#�_ , , 41D R0'Zr.,,..zP . Onl agn, <br /> E. DESCRIEMON <br /> Tv <br /> pe of Discharge: C t S T <br /> Volume: Gt-, <br /> Chemicals: <br /> C1rcurnstances ,agL oflLrrJ1L� �h <br /> 6\-u <br /> F. ACTION TAKEN U T lt4 ALU <br /> SITE DISPOSITION . <br /> EH 22 013 (Re%% 08120/98) <br />