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a <br /> SAN JOAQUIN COUNTY „ <br /> NOTIk•ICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 ! <br /> A. EMERGENCY LEVEL;,j01II III PHS-EH LOG # l Z4 6:9 <br /> (Circle One) <br /> B. SOURCE OF INFORMATION i E <br /> Name: Cc. Re.S L Li.. .. _ u Phone: <br /> Company: --- IN <br /> Address: �I <br /> Designated Employee Name: I Phone: ���.3s� <br /> Reporting Agency Name: <br /> Address: Il <br /> i <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: <br /> (Best Physical Desc 'ption) L (Ci County) Circle One i <br /> Date of Discharge: <br /> Date Notified: Z/ —f G 2/ , Time: 'Ir/C�`O D a mJ <br /> D. RESPONSIBLE PERSON BUSINESS <br /> Name of Business: Py <br /> Contact Person: S ill Telephone: I 62, <br /> Physical Address: r� ,� h. C,, o <br /> ;r <br /> Mailing Address: UinC kZ a, F <br /> i� <br /> E. DESCRIPTION II <br /> Type of Discharge: 0 y e r`� <br /> Volume: li <br /> Chemicals: l. 1 <br /> Circumstances: '" <br /> cc <br /> F. AC'T'ION TAKEN W <br /> a , <br /> t 7 i <br /> .Ili i <br /> S E DISPOSITION r L <br /> a <br /> l <br /> 6 it <br /> ii <br /> it <br /> EH 22 013 (Rev.4/91) i <br />