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SAN JOAQUIN COUNTY ...r <br /> . NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> S-EH LOG � <br /> A. EMERGENCY LEVEL: I II III PH <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Phone: �� <br /> Company: <br /> Address:Designated Employee Name: Phone: <br /> Reporting Agency Name: <br /> Address:! X152 <br /> C. LOCATION AND DATE OF ISCHARGE <br /> Locarion: / <br /> (Best Physical D cri rion) Ci or County) Circle One <br /> Date of Discharge: aIQ Pi <br /> Date Notified: Time: o 1 co a D. RESPONSIBLE PERSON�BUSINESS� <br /> Name of Business: <br /> Contact Person: Telephone: (2v°t) Y3/f— ! Iz56 <br /> Physical Address: ?a oD 1-6�14 .�,;,� i Ate_►, �4- C��3?1� <br /> Mailing Address: �dn�E <br /> E. DESCRIPTION <br /> Type of Discharge: ;r< Y <br /> Volume: l�t`lr�ow rJ <br /> Chemicals: IDI a�ol <br /> Circumstances: t j k)tj ku-t�n-ag-7 Qi Ufa -5- 4-vun <br /> F. ACTION TARN ��1y11C- .J�•� TZ�r✓�r��� <br /> SITE STATUS "��•J e-,;,n;NLC <br /> EH 22 013 (Rev.4/91) <br />