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SAY JOAQUL`� COUNTY <br /> YO=C.ATION OF B AZARDOUS WASTE 2: DISCH. E A`V-O p y <br /> M-v,LTH & SAFETY CODE 130-7 <br /> A. EMERGENCY LEVEL:LQ II III PSIS-EH LOG <br /> (Circ!e one) <br /> B. SOURCE OF iNFOMATION <br /> dame: y <br /> G-�� ..� G�G�y Phone: (1,4 .44 3 — 7 7/l, <br /> CamDanv: <br /> Adaress: <br /> Designated Emolover Name: Phone: d <br /> Reporting A?encv Name: <br /> Address: <br /> C. LOCATION:VV-D DATE OF DISCHARGE <br /> E vym n;.,,��S-�- <br /> Location:c - - — <br /> (Best Phvsicai Description) (City or ounz4) Circle one <br /> Date or Dische: <br /> Date Notified: -- ime: D ate. <br /> D. RESPONSIBLE PERSON/BUSUNESS <br /> Name of Business: <br /> Conti Person: S <br /> Phvsical Address: <br /> Maihng Address: ot,4 <br /> IPTI <br /> R44 <br /> E. DESCRON <br /> T%-pe or Dische: <br /> Volume <br /> Chemicals: e sS <br /> Circums ncees: inn 72V <br /> F. AC N T.�KEN <br /> je <br /> 'GQ ` <br /> SITE ISPOSITION <br /> Jay "24 lee <br /> lorlooll <br /> EH 22 0l-- lRev. 03!'20/93) <br />