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• v <br /> `.✓ SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARG <br /> HEALTH & SAFETY CODE 25180.7 1� <br /> A. EMERGENCY LEVEL: 1 II 111 PHS-EH LOG # r O <br /> ( ircle One) <br /> B. O INFO TION <br /> Name: / 7 6� 2�9 Phone: <br /> Name: <br /> Company: <br /> Address: <br /> Designated Employee Name: Phone: (_) <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION ANN PATE OF DISCHARGE <br /> Location: 30 F. � / SY 7/✓ <br /> (Best Physical Description) (IlcityDr County) Circle One <br /> Date of Discharge: toW&AQ u//�/ <br /> Date Notified: (v ZU Time: a.�.. <br /> D. SPONSIBLE PERSON/BUSINESS Cp .L/QST . <br /> Name of Business: 165AJW6=W • <br /> Contact Person: /Telephone: <br /> Physical Address: L W <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: <br /> Chemicals: • C`i2 L `— <br /> Circumstances <br /> Ga P <br /> F. ACTION TAKEN U <br /> Z <br /> oc <br /> SITE STATUS ! <br /> 49 4:2 <br /> E <br /> EH 22 013 (Rev.4/91) <br />