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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 <br /> Name: Phone: Q cq o 7-033Z <br /> Company: G .E <br /> Address: a <br /> Designated Employee Name: Phone: (� <br /> Reporting Agency Name: vz <br /> Address: dam— —6; p u.n G <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: <br /> (Best Physical Desc 'prion) (City Coun Circle One <br /> Date of Discharge: ria U-1 <br /> Date Noted: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: &IdeOP2 <br /> Contact Person: X'w Telephone: --�-F <br /> Physical Address: i:2 "°' ar ��, cam. `�—'6 Z <br /> Mailing Address: C- <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: , (Zdd Ad - <br /> Chemicals: �- <br /> Circumstances: xa,G �!V c u <br /> F. ACTION AKEN 0 Xi 4 6 46" <br /> r lt4 i4'-t <br /> SITE DISPOSITI N <br /> �G <br /> Gcr <br /> E <br /> EH 22 013 (Rev.4/91) <br />