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V SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:OU III Pf�IS-EH, LOG D <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: iE Phone: <br /> Company: <br /> Address: it <br /> Designated Employee Name: 1 cd Ao e, Phone: CIET --03-34,- <br /> -) <br /> Reporting Agency Name: E-WO <br /> Address: /-, <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location:- zz-7az- -5. 1,Av (7� <br /> (Best Physical Description) (City or County) Circle One <br /> Date of Discharge: <br /> Date Notified: ";T- y 2-- Time: i1 3,ecn <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: 1\"l co -7rj C- P) Z-" :i <br /> Contact Person:- 1_1 o. ne C"N telephone: (1,07) s9s--e-i i z- <br /> Physical Address: 7r--7 -L-z- <br /> MailingAddress: 21g44c-,N CD; Z� c-IA e 1C\r <br /> E. DESCRIPTION <br /> Type of Discharge: el-4. <br /> Volume: <br /> Zoe <br /> Chemicals: <br /> Circumstances: <br /> F. ACTION TAKEN SA- <br /> CIZZ ell/ 4 74 e-- <br /> SITE DISPOSITION <br /> iE <br /> Ik <br /> EH 22 013 (Rev.4/91) <br />