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I - v <br /> a [PY SAN JOAQLIIN COUNTY �`•.•,� <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG <br /> Cfrcle One <br /> B. SOURCE OF INFORMATION <br /> Name: Phone: (_) <br /> Company: <br /> Address: <br /> Designated Employee Name: Phone: <br /> Reporting Agency Name: �Q Tc �ti. ,jr�,,,,, <br /> Address: fir/ .� r✓ Sc-" <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 7,0,,Q oV-i -r-. / 0(r, <br /> (Best Physical Description) i or County) Circle One <br /> Date of Discharge: (,L <br /> Date Notified: _S- 3 -g�r Time: J/.' ay Rri <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: pldaov, <br /> Contact Person: �i �, /3� � ��. Telephone: (Z,vS) y 4 6 -f:kjY, <br /> Physical Address: -6 <br /> Mailing Address: ,0. <br /> E. DESCRIPTION <br /> Type of Discharge: ( �.� , u d- �, jZdj14,,,>L, <br /> Volume: <br /> Chemicals: <br /> CircGtances: <br /> F. ACTION TAKEN 7/0 <br /> SITE DISPOSITION__ ��,��,,v.�- <br /> EH 22 013 (Rev.4/91) <br />