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%001 SAY JOAQUI N COUNTY '*-.d <br /> NOTEnCATION OF HAZARDOUS WASTE D(ScHAIEE COPY <br /> HE.kLTH & SAFETY CODE 25180.i <br /> A. EMERGENCY LEVEA,I II III PHS-EIS LOG 4 l 1 - `3 <br /> etrcle one) <br /> B. SOURCE OF INFORMATION <br /> Name: hone: )Company- M UA <br /> Address:_ f Af ek r�--A- , - <br /> Designated Employer Name: Phone: <br /> Reporting Agency Name: S` M <br /> Address: r <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 25 ` H W 1/ �q / �(;q <br /> {Best Physical Descripao� (City.or County) Circle one <br /> Date of Discharge: 1J ) 4kr AJ <br /> Date Notified: 0 i Time: <br /> I PM <br /> D. RESPONSIBLE PERSONMUSINESS <br /> Name of Business: i A-v ro <br /> Contact Person. M Vc 51 N G H Phone: G <br /> Phvsical Address: 2 `fig 0 C " <br /> Mailing address: �` y <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: ;,J A-) <br /> Chemicals: /V e = <br /> r ' i` I <br /> Circumstances: <br /> ���/✓ ✓ /: �'n cJ � <br /> � <br /> F. ACTION T. KEN �I�S <br /> SITE DISPOSITI N <br /> EH 22 013 (Rev.0312(/98) <br />