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SAN JOAQUIiN COU-N- Ty <br /> NO'T'IFICATION OF ELAZARDOUS WASTE DISC$-kRG f ILE <br /> COPY <br /> HEALTH & SAFETY CODE 2-4130.7 <br /> A. ELIERGENCY LEVEII III PHS-EH LOG T 0 ' 003 <br /> 0- ircle one) <br /> B. SOURCE OF INFOIZNIATION <br /> Name: <br /> Z- <br /> Compa7fnv- <br /> Phone:�e2 <br /> Address: vt0 O a vg <br /> Designated Employee Name: Phone: c�9 <br /> Reporting Agencv Name: <br /> Address: -' <br /> C. LOCATION AND DATE OF/DISCHARGE <br /> Location: ts,6 . <br /> (Best Phvsicai Descripuon) dspr County) Circle one <br /> Date of Discharge: �h�'�`'�'`�J <br /> Date Nouned: Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: 4 r''r U <br /> Contact Person: u Phone:an g <br /> Phvsical address: U f <br /> Mailing address: G `� <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: U^r> <br /> Chern, is. � a//,v <br /> Circumstances: <br /> ell <br /> F. ACTION TAKEN / = <br /> SITE DISPOSITION ✓ z ` / c� (� ' <br /> EH Z::0 l= i Rev. 03!.0/93) <br />