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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> —0( <br /> A. EMERGENCY LEVEL: I ft III PHS-EH LOG T <br /> (Circle One) <br /> B. SOURCE OF INFORMATION Phone• (_) <br /> Name: <br /> Company. (" ora�J4t,�-ry avc� <br /> Address: Phone: <br /> Designated Employee Name: <br /> Reporting Agency Name: _ r <br /> Address <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location•• 6� I ��'t� <br /> (City or County) Circle One <br /> (Best Physical Pe�cripTn) <br /> Date of Discharge: ��� °i'` <br /> Date Notified: r /` Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: ,-'�,i rr`94 " S 4 <br /> Contact Person: O�6:CY Telephone: (2---L) <br /> Physical Address: <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: vn� ,�wr`� <br /> Volume: <br /> Chemicals: <br /> Circumstances: o s��T ''�''y �•l° �" sT = <br /> F. ACTION TAKEN <br /> SITE DISPOSITION <br /> E:: 22 013 (Rev.4/91) <br />