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SAN JOAQULN COUNTY <br /> NO=ALTION OF FT.AZARDOLTS WASTL DISCPARGE <br /> fm,kLTH & SAFETY CODE ZS180.7 <br /> A. EMERGENCY LEVEE a)n III PHS-EH LOC: # 00 <br /> (Circle One) <br /> B. SOURCE OF [NF0 ON <br /> Name: G Phone ,� ,f D7 <br /> Company: <br /> Address % ' � D <br /> Designated Employee Name: !' `fi Phone: <br /> Reporting AgA-ncy Name: <br /> Address: <br /> C. LOCATION AMD DAin OF DISCHARGE <br /> Location: b 1 a S A r 0,1 .Seo <br /> (Best Physi esapn (City o unty Circle One <br /> Date of Dis&-arge: —J 0 —z' f)— <br /> r <br /> Date Nodded: ime: 9 ; 00 c� <br /> D. RESPONSIBLE PERSON/BUSIENESS <br /> Name of Business: P, G <br /> Contact Person: Tele.hene:tZ;6 <br /> Physical Address: !Vf-73 L() ion kzt--n-P _ ; wrljo <br /> Mailing, Address: &'•� �2" Jnr <br /> /?�E. DESCRIP' : <br /> Type a v I <br /> Volume: <br /> Chemicals: <br /> Circ=mst�^_ties: � <br /> F ACTION TAMN i4 e <br /> Q <br /> SITE STATUS 1,6 - J`.5 LG <br /> EH 22 013 (Rev.4/91) <br />