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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> C(OP <br /> I <br /> A. EMERGENCY LEVEL: � II III PHS-EH LOG <br /> ( ircle One) <br /> i <br /> B. SOURCE OF INFORMATION <br /> Name: 6ACIA�� „-_ Phone: <br /> Company: - <br /> Address: ��?` 3� . - ;t;� u=L r✓�4 raw. �1-..�i � 5� <br /> Designated Employee Nance: Phone: �) <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DAT�-OF DISCHARGE <br /> Location: <br /> (Best Physical Desc4pti ) (r County) Circle One <br /> Date of Discharge: ^�� <br /> Date Notified: 1 9 to Time: ,'00F-9111 <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: fij��r_a&9- <br /> Contact Person: ltl'i iu_ t a_^,�_ !u�, ~ Telephone: (� i <br /> Physical Address: <br /> Mailing Address: I U cR-",A— - - — <br /> E. DESCRIPTION r <br /> Type of Discharge: �. _ AZ <br /> Volume: <br /> Chemicals: a� � � <br /> Circumstance : � <br /> I <br /> F. ACTION TAKEN rz.�� �' cn1 r w r o ��-Nom'- •�� <br /> I <br /> SITE DISPOSITION <br /> EH 22 013 (Rev.4/91) <br /> II <br /> I <br />