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0 <br />SAN JOAQUIN COUNTY 0 <br />NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br />HEALTH & SAFETY CODE 25180.7 <br />A. EMERGENCY LEVEL: I II III <br />(cle One) <br />B. SOURCE OF INFORMATION <br />Name: <br />Company: _ 0d <br />nuul GJJ. g- , . Swn -- <br />Designated Employee Name: <br />Reporting Agency Name:_ <br />Address: <br />C. LOCATION AND DATE OF DI <br />Location: 4'?0> 6V ' 6 <br />(Best Physical Descri <br />Date of Discharge: <br />Date Notified: <br />.iij <br />PHS-EH LOG # <br />LARGE % p - <br />(�vT�'� �Yl Y -P. <br />Time: <br />Z <br />Phone: (d,) X10" 51109 <br />Phone: (_ ) <br />County) Circle One <br />D. RESPONSIBLE PERSON/SU51Nhb� ' " <br />j33 <br />Name of Business: <br />Contact Person: Telephone: <br />Physical Address of bal6�- <br />Mailing Address: <br />E. DESCRII <br />Type of <br />Volume: <br />Chemica <br />Circums- <br />F. <br />EH 22 013 (Rev.4/91) <br />