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SAN JOAQURq COUNTY, <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> -HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:(IIII PHS-EH LOG- <br /> (Circle o ) <br /> B. SOURCE OF INFORMATION <br /> Name: Phone: " @L �J`��7 <br /> CompanyA. - ti. . <br /> Address:\-7!5W1 'PNcx> �- N <br /> Designated Employee Name: Phone: <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> flys <br /> Location:utiX - <br /> (Best Physical Description) (City or County) Circle one <br /> Date of Discharge: <br /> Date Notified: "] Time: tQ_%So <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: C ��C:r�, <br /> • Contact Person: Phone: \ <br /> Physical Address: '\\NGj <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: Q-t <br /> Volume: vs�Y�ctJ <br /> Chemicals: Spic . <br /> Circumstances: <br /> F. ACTION TAKEN � � <br /> SITE DISPOSITION <br /> EH 22 013 (Rev. 08/20/98) <br />