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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE ,/. <br /> HEALTH & SAFETY CODE 25180.7 <br /> t <br /> A. EMERGENCY LEVEL: I% S-EH LOG # <br /> , <br /> (CirclI III Cc <br /> e One) <br /> B. SOURCE OF INFO TION <br /> Name: Yl S. - Phone: <br /> Company: ✓' + S <br /> Address: 2� 0 c CrC{ F7 <br /> Designated Employee Name: Phone: (�) <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: �;L�I 7 L0nrY;1c <br /> (Best Physical Description) (City or oun Circle One <br /> Date of Discharge: <br /> Date Notified: I D i 11rig- Time::SOD eM <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: <br /> Contact Person: r' Telephone: - (*7 <br /> Physical Address: 7 3 Ih�rn75 �.tiM , as`�o <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharger . <br /> , G <br /> Volume: VI <br /> Chemicals <br /> Circumstances: -s <br /> E ` S <br /> F. ACTION TAKEN J6-1- MYLOUdA � 19RI d nJtS ri C4P: . <br /> SITE DISPOSITION svz `k s ,rre Cir' <br /> n� 8Yt <br /> EH 22 013 (Rev.4/91) <br />