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ISR <br /> SAN JOAQUIN COUNTY /7 <br /> N IFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: (1) II III PHS-EH LOG #Circ <br /> le One) <br /> B. SOURCE OF INFOName: [ 3Phone: ( � <br /> Company: u-,— �- <br /> Address: E - r= c T. �- �S� 6 <br /> Phone: ( <br /> Designated Employe Name: (2-o-0y X( <br /> Reportingenc N e: �-� <br /> Address: �04�- <br /> I <br /> C. LOCATION AND DATE OW DISCHARGE <br /> Location �� 5 T�'car ie a� err 72, / <br /> (Best Physi 71 escription) U (City.or County) Circle One <br /> Date of Discharge <br /> - �Ll <br /> Date Notified: Time: :Ob <br /> D. RESPONSIBLE PERS N/BUSIN n ', <br /> Name of Business: <br /> Contact Person: Telephone: --) - S <br /> Physical Address: J r <br /> Mailing Address: fly—F—, <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: G <br /> Chemicals: - _ <br /> Circumstances: <br /> F. ACTION TAKEN <br /> OQ <br /> SITE STATUS + ' <br /> `t <br /> EH 22 013 (Rev.4/91) <br />