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FILE COPY <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE _ <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LE I II III PHS-EH LOG f <br /> 1rcle one) <br /> B. SOURCE OF INFORMATION <br /> CC <br /> Name: Lulz_ X1/1 l��( � ��c. Phone: <br /> Company: <br /> Address: U f . - Qi `rr <br /> Designated mployee Name: S Phone: <br /> Reporting Agency Name: 1 Ce ns <br /> Address:_ 3 6!A _ U3CV_� <br /> C. LOCATION AND DATE OF DISCHARGE &o7 <br /> Location: (Best Physical Description) r County) Circle one <br /> Date of Discharge: <br /> Time: <br /> Date Notified: ��•?,C� o�t�. <br /> D. RESPONSIBLE PERSONBUSINESS <br /> Name of Business: �(� � <br /> Contact Person: Phone. <br /> Phvsical Address: OL <br /> Mailing Address: <br /> E. DESCRIPTION <br /> TNW of Discharge: <br /> Volume: 1 �- <br /> Chemicals: VIK—tb <br /> Circumstances: i <br /> F. ACTION TAKEN <br /> SITE DISPOSITION <br /> EH 22 013 (Rev. 08/20/98) <br />