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FILE COPY <br /> OSAN JOAQUIN COUNTY <br /> p ti� NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVE I II III EH LOG� <br /> LO one) <br /> B. SOURCE OF INFORMATION <br /> 0 <br /> Name: /i —a✓� Phone: ( a 5 _ 9 <br /> Company: of s i C • n �/•f' n L2f O f'1,Ft GA <br /> Address: 1 r e <br /> Phone: <br /> Designated Employee Name: <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> dao 6 'E , /n( /? e-/ <br /> Location: City r County) Circle one <br /> (Best Phys)cal Description) <br /> Date of Discharge: /l '1 0 <br /> Time: `1::30 <br /> Date Notified: a? <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> T D 5 a-+✓��r /l <br /> Name of Business: �A `f Phone: <br /> Contact Person: e <br /> Phvsical Address: ' ryx <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: l <br /> Chemicals: <br /> Circum�� ,e <br /> s: � <br /> On <br /> F. ACTION T.aKEN /�(o n e — <br /> SITE <br /> DISPOSITION 1E �01 e Vy\- <br /> t 5-, F <br /> EH 22 013 (Rev. 08/20/98) <br />