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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE (� �' <br /> HEALTH & SAFETY CODE 25180 .7 <br /> A. EMERGENCY LEVEL: ILII III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATIO `� � � <br /> Name: Le - Ce >^ iGGS Phone: '51 >.-- .3! _S;/ <br /> Company: V `J <br /> Address : <br /> Designated Employee Name : c Phone: e.6c ) � <br /> Reporting Agency Name: <br /> Address : <br /> Co LOCATION AND DATE Ql DISCHARGE /1 <br /> Location: .� : <br /> (Best Physical Description) (Ci or County) Circle One <br /> Date of Discharge: <br /> Date Notified: Time: <br /> D . RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: �' /�/I fZ <br /> Contact Person: L /go E Telephone: c A72 — 4;*_5 / <br /> Physical Address: I000 `�� <br /> Mailing Address : <br /> E. DESCRIPTION 1 <br /> Type of Discharge: �� AR �O � � ✓` l l -� O i QlMG <br /> volume: O a <br /> Chemicals: <br /> Circumst ces: `7' % <br /> F. ACTION TAKEN n <br /> 9-� ' _ 4 <br /> oo ' v, S1Y 0 <br /> / CEiI <br /> G01 <br /> Sl ISPOSITION . 'S <br /> 4 <br /> G <br /> � a <br /> � <br /> EH 22 013 (Rev.4/91 ) � , <br />