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SAN JOAQUIN COUNTY " <br /> FILE COPY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. ENIERGENCY LEVEL II III <br /> PHS-EH LOG g OO ' o.1 <br /> ( ircle one) <br /> B. SOURCE OF INFORi��IATION <br /> Name: { Phone: � <br /> Company: <br /> Address: d 1 0 Phone: <br /> Designated Employee Name: <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: S <br /> U (City or ounty) Circle one <br /> (Best Physical Description) <br /> Date of Discharge: lAv� u-y f� <br /> Date Notified: Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: 4c, � r f - <br /> Phone: S <br /> Contact Person: <br /> Physical Address: 1 6S 5 33 b <br /> Mailing Address: a Lie r� <br /> E. DESCRIPTION <br /> Type of Discharge: L2 <br /> Volume: <br /> n <br /> eChemicals �t�T-Orn\ <br /> pCircumstances: r,0 rv\Q" ryI ' "A�leyrtlu r�J <br /> ►� a r a <br /> F. ACTION TAKEN A7 6 e S-�ar-a � Pio n � <br /> r <br /> SITE DISPOSITION e r, e, <br /> n nOL. <br /> EH 22 013 (Rev.08/20/98) <br />