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SAN JOAQUIN COT-WIY <br /> NOT:rIG4TI0N OF HAZARDOUS WAST_ D[SGL ARGE FILE COPY <br /> TcI & SAtETY CODE ZSI80.7 <br /> X <br /> A. EMERGENCY LEVEL. T 11 1111 PHS-EH LOG: <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: 0i // P_- Phone: j'fE 7-1GC6 <br /> Company: Af ;n <br /> Address: <br /> Designated Employee Name: L, io`o-T Phone: Q ori - 70 <br /> Report ng Agency Name: <br /> Address: " <br /> +� <br /> C. LOCATION AND DA EE OF DISC.-TARGE <br /> Location: S-f / +CG(Y`yGrri as ^� S <br /> (Best Physical Des=pdon) (City o ounry Circle One <br /> Date of Discharge: /i <br /> DaEe Noaned: (4—1 1 - 99Time: <br /> RESPONSI3Lv PERSONS( Su�lESS <br /> Name of Business: <br /> Contact Person: _ Tzeohcne: (-Z6 1) <br /> Physical Address: <br /> Ylaling Address: <br /> _. <br /> DESCRIPTION <br /> Tvpe of Disc:-iar;e: [LAR is 4 F/ 3 <br /> Volume: 2 h-,!v y:a A- <br /> Chemicals: D -- <br /> Circumstances: gn %, yr b m�reF <br /> F ON T,-lI(EN <br /> A <br /> �7 ✓(SIA f•�.. b���• _, � <br /> i <br /> SL c STATUS <br /> ne <br /> T J <br />