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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: (I II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION Phone: (I&L) <br /> Name: I C <br /> Company: Cev✓u-Q <br /> Address: 3) <br /> Designated Employee Name: u tic Phone: <br /> Reporting A en Name: u, ✓ ` <br /> Address: 2�a <br /> C. LOCATION AICD DATE F DISCHARGE / <br /> Location: <br /> (Best Physical Des4ior��Cogu—nty)cription) Circle One <br /> Date of Discharge: 1/tA LX,, 1 <br /> Date Notified: Z? Time: ID, &D 444A <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: S 98Z Zo93 <br /> Contact Person: 0 Telephone: (YE) <br /> Physical Address Nn <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharp s <br /> Volume: <br /> Chemicals: C� <br /> Circumstances: rA/LYl <br /> F. ACTION TAKEN t <br /> SITE DISPOSITION <br /> /fat r�CL2 <br /> EH 22 013 (Rev.4/91) <br />