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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARG> ILE COPY <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL®rc <br /> II III PHS-EH LOG# E)9 <br /> le one) <br /> B. SOURCE OF INFORMATION <br /> Name: P�C <br /> Phoma. <br /> Com an <br /> P Y� �- <br /> Address: -S Phone:vZp9 <br /> Designated Employee Name: <br /> Reporting Agency Name: <br /> Address: TOV147 alrl, q 7 46 Z <br /> _C Z 71 <br /> C. LOCATION AND DATE OF DISCHARGE 5 <br /> Location: <br /> (Best Phys al D scnption) Ci r County) Circle one <br /> Date of Discharge: P '-/ <br /> Date Notified: / ` Time:�0 //D. RESPONSIBLE RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: y'l .�� � phone: 3� <br /> Contact Person: <br /> Physical Address: G <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: <br /> Chemicals: <br /> Circumstances: <br /> F. ACTION TAKEN <br /> r <br /> SITE DISPOSITION % V <br /> EH 22 013 (Rev.08/20/98) <br /> I <br />