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SAN JOAQUIN COUNTY <br /> NOTIFATION OF HAZARDOUS WASTE DY-1-LARGE. <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL <br /> I II III PHS-EH LOG <br /> (Circle One) <br /> B. SOURCE OF INFORMATION phone: D <br /> Name: <br /> Company: <br /> Address: lqbf <br /> Designated Employee Name: Phone: <br /> Reporting Agency Name: <br /> Address: �` Ot <br /> r <br /> C. LOCATION AND DATE OF DISCHARGE <br /> / w <br /> Location:. /D u 0 &D 2'9 '� $�4 <br /> (Best Physical Description) ity r County) Circle One <br /> Date of Discharge: <br /> Date Notified: 5 - 45— Time: a <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: ` <br /> Contact Person: Telephone: (_„ } <br /> Physical Address: <br /> Mailing Address: `3 <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> volurne: <br /> Chemicals: <br /> Circumstances: <br /> F. ACTION TAKEN <br /> SITE STATUS 5 k s <br /> 4- <br /> TMN <br /> EH 22 013 (Rev.4/91) <br />