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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE � <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:fi II III PHS-EH LOG 01 -- <br /> ( ,ircic One) <br /> B. SOURCE <br /> <C �FORNATION Phone: (j/(0/) T67 <br /> Name: <br /> Company: ao0� e.✓crf� �o eao✓�4, 9�� <br /> Address: llD� S(JNCT�� Phone: <br /> Designated Employee Name: <br /> Reporting Agency Name: <br /> Address: - <br /> C. LOCATIO.� ANDD DATE OF DISCHARGE <br /> Location:_T/r <br /> (Best Physical Description) Ci or County) Circle One <br /> Date of Discharge: N,E'iyOG�Ji✓ <br /> Date Notified: J27''0S Time• _��'`� -- <br /> D. RESPONSIBLE PERSON/BUSTNESS T ��c%r� /k <br /> Name of Business: _1l/ .._�� <br /> Contact Person: _ GiG DO. ___ _ Telephone: (_) <br /> Physical Address: �83� 0 _ <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: U ^'o — ---- <br /> Volume: <br /> Chemicals: <br /> Circumstances:� o �7,*L?� _ <br /> F. ACTION TAKEN – U/Q` <br /> SITE DISPOSITION_ <br /> EH 22 013 (Rev.4/91) <br />