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SAN JOAQ UIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 co <br /> [ply <br /> A. EMERGENCY LEVE II III PHS-EH LOG # 7 �' <br /> �cle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Phone: L� <br /> Company: <br /> Address: <br /> Designated Employee Name: Phone. _ <br /> Reporting Agency N7: -Sa,,. ;. <br /> Address: S s o4 CA-� sw I <br /> C. LOCATION AND DATE OF DISCHARGE µ --� <br /> Location: %� f zc" _ nlu.✓.67M do-w� a* <br /> (Best Physical Description) (City or Circle One <br /> Date of Discharge: <br /> Date Notified: 4 - / ti - r Time: Z'• OcD ©M . <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: . .S, WrWj <br /> Contact Person: Telephone: (zz?r ) s -o <br /> Physical Address: jZo4,Yt, a <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: f)u�-nj kG— e . <br /> Volume: <br /> Chemicals: t94 <br /> Circumstances: <br /> dllr� v i ems. <br /> F. ACTION TAKEN wc4oCrJ l k 1 <br /> SITE DISPOSITION <br /> F,H 22 013 (Rev.4/91) <br />