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... SAN JOAQUIN COUNTY <br /> YOTgiCATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVELD II III EH LAG <br /> (Circle one) <br /> B. SOURCE OF INFORMATION <br /> �� <br /> Name: <br /> Company: j 7j <br /> Address: 0 -7$ <br /> Phone: <br /> Designated Employee dame: <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> ,3�l 5 <br /> Location: ity r ounty) Circle one <br /> (Best Physical Description) <br /> Date of Discharge: Time: � <br /> Date Notified: 3 <br /> D_ RESPONSIBLE PERSONIBliSINESS <br /> dame of Business: Phone: -5,51L -$ R3 <br /> Contact Person: <br /> Phvsical address: 7 <br /> Mailing Address: 6 <br /> E. DESCRIPTION <br /> Type of Dischar-e: <br /> Volume: <br /> Chemicals: <br /> C ircumstances: tri- <br /> F, ACTION TAKEN <br /> SITE DISpOSfI'ION <br /> EH 22 013 (Rev. 08/24/93) <br />