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i SAN JOAQUIN COUNTY -� <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: Q II III PHS-EH LOG <br /> (Circle One) <br /> B. SOURCE OF INFO TION <br /> Name: . /•E• . 7.Sec.Q e45 vA t s Phone: 101, ilk - <br /> Company: 2vd44j=egOar►z�-- <br /> Address: , 9/ 52,0 <br /> Designated Employee Name: Phone: (� <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION ASN,PD'DATE OF DISCHARGE J / / / <br /> Location:fg N. <br /> bir✓lo <br /> (Best Physical Description) (City or ounty) Circle bne <br /> Date of Discharge: �JN�('�t/DuJ41l <br /> Date Notified: 7 Time: .304- <br /> D. RESPONSIBLE PERSON BUSINESy <br /> Name of Business: B-5 / �— <br /> Contact Person: Telephone: 6 <br /> Physical Address: <br /> Mailing Address: 3reAlele4, CA lip 7- 1�07-3 <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: <br /> Chemicals: <br /> Circumstances: <br /> F. ACTION TAKEN <br /> G� CJ-P.0 <br /> /,Op I eL11 <br /> U <br /> SITE STATUS — <br /> r <br /> E <br /> EH 22 013 (Rev.4/91) <br />