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SAN jOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> f _ \.;P,HS-EH LOG # <br /> A. EMERGENCY LEVEL: II III .�� r f r <br /> (Circle One) <br /> B. SOURCE OTr NFO TION/ �'�-3`' �� <br /> Name: 5 �- So rn APs Phone: <br /> 77 <br /> Company: - <br /> Address- f0 _ Crit+ .,�_� -•���4C�sl''' <br /> Designated Employee Name: Phone: CaLoqD <br /> Reporting Agency Name: i •� G S P� `�c <br /> Address: Y S <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: s5-0 c. <br /> (Best Physical Description) City r County) Circle One <br /> Date of Discharge: <br /> Date Notified: Time: <br /> D. RESPONSIBLE PERSON/BUSINESS _ # <br /> Name of Business: <br /> d <br /> Contact Person:- rn Telephone: QaD - 7 <br /> Physical Address: <br /> nq <br /> t Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge:, .-7 a 44 <br /> Volume: u <br /> Chemicals: <br /> f <br /> Circumstances: <br /> Circumstances: <br /> d <br /> s <br /> F. ACTION TAKEN -za ak,C u-eL- die <br /> N <br /> SITE DISPOSITION Z,), I 7711 "aces S <br /> i d <br /> { EH 22 013 (Rev-4/91) <br />