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SAN JOAQUIN COUNTY <br />NOTIFICATION OF HAzARDOUS WASTE DISCHARGE <br />HEALTH & SAFETY CODE 25180.7 <br />A. EMERGENCY LEVEL:11 111 <br />( PL"rcle One) <br />PHS -EH LOG # 22 <br />B. SOURCE OF INFORMATION Phone: (1-9) <br />Name: 7' <br />Company- 'Oep <br />Address: AeTaxlev Phone: (30 <br />Designated Employee <br />Reporting Agency Name: U1,0vI 421-61VQ <br />Address: 9 !9:d- 25202 <br />C. LOCATION AND DATE OF DISCHARGE <br />(Best Physical Description) <br />Date of Discharge: 2O <br />Date Notifle( <br />Time: <br />(nor County) Circle One <br />D. RESPONSIBLE PERSON/BUSINESS <br />Name of Business: :6l -l14- --- 5 <br />Contact Person: &,-w a: Z: TTelephone: C�ycj) 6 a - <br />Physical Address: J—q ET- 12 <br />Mailing Address: <br />E. DESCRIPTION <br />Type of Discharge: <br />Volume: 4/0 <br />Chemicals: <br />Circumstances: LRI vy - Q 6eE <br />-a <br />SITE DISPOSITION <br />