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O • SAN JOAQUIN COUNTY i FILE COP Y <br /> D OTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> �D <br /> A. EMERGENCY LEVELS 1 11 III EH LOG # n,,2 — CMZ <br /> ( ircle One) <br /> B. SOURCE OF INFO ATI <br /> Name. Ov� Phone: L5 /{2(0' ZloOU <br /> Company: �ce — CzS oOb <br /> Address: oGL Uzi <br /> Designated Employee Name: Phone: (_) <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DAT OF DISCHARGGE/ <br /> Location:,46 <br /> (Bes�Physical Description) (C19or Co ty) Circle One <br /> Date of Discharge: <br /> Date Notified: to Time: <br /> D. RESPONSIBLE PERSON/BSIS <br /> Name of Business: <br /> Contact Person: s Telephone: ( Z <br /> Physical Address: 2—52— <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: �— <br /> Volume: d <br /> Chemicals: <br /> Circumstances: <br /> F. ACTION TAKEN — c ewa <br /> SITE DISPOSITION <br /> mQ <br /> EH 22 013 (Rev.4/91) <br />