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UNTY <br /> SAN JOAQUIN CO <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> MEiUENCY LEVEL: 1 11 111 PHS-EH LOG # <br /> (Pircle One) <br /> B. SOURCE OF INFORMATION Phone: Y00 z- <br /> Name: bov-m <br /> Company: 'D-t0C4;b— <br /> Address:- !S�n 4zAr-- Phone: <br /> Designated Employee Name: <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE sio <br /> Location: 2 S 2 <br /> (Best Physical Description Y (City or County) Circle One <br /> Date of Discharge: -111 (a lq� <br /> DateNotified: 111&Tqi- Time: T'00 A,"-A <br /> I F---- <br /> D. RESPONSIBLE PERS QN/BUSINESS <br /> Name of Business. 0 &J_, PaotA, e 0 <br /> Contact Person: Telephone: r--mlz- <br /> Physical Address: D-S2.,10 1,62, .WOSL <br /> Mailing Address: 25IYa- <br /> E. DESCRIPTION <br /> Type of Discharge---- <br /> Volume: 0 <br /> Chemicals:N !az,sod <br /> Circumstances: <br /> F. ACTION TAKEN,&X <br /> 1,?A OZ4 a <br /> SITE STATUS <br /> ip. <br /> /ht 01 <br /> (T-- <br /> � <br /> EH 22 013 (Rev-4/91) <br />