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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I1 III PF-'S-EH LOG # 9C�2 <br /> (Circle One) <br /> B. SOURCE OF INFORMAT Qin <br /> Name: - L4A-7-65•G i Phone: 9/ SSS <br /> Company: �• va,, — <br /> Address: SD�b � .T✓ 'fie � . �`� a p` a— <br /> Designated Employee Name: Phone: �) <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: f F — -�' / SgjC,k <br /> (Best Physical Description) City r County) Circle One <br /> Date of Discharge: <br /> Date Notified: 6/F 9Z _ Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: aett Lw <br /> Contact Person: Telephone: (oi�?) 583 SS,Z/ <br /> Physical Address: .a5 <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: <br /> Chemicals: <br /> Circumstances: E <br /> F. ACTION TAKEN -,3 <br /> SITE DISPOSITION — <br /> ?,L e 7- <br /> EH <br /> EH 22 013 (Rev.4/91) <br />