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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DIS GE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:L, cle <br /> II III PHS-EH LOG # G� <br /> ( One) <br /> B. SOURCE O "ORMATION <br /> L <br /> Name: Phone: �� 1 <br /> Company: �_cf <br /> Address: i7.► ° 2` - 03 <br /> Designated Employee Name: Phone: <br /> Reporting Agency Name: aµ 1141 <br /> Address: _ ..S �"'�^" C& 5 z z.o Z'. <br /> C. LOCATION AND ATE OF DISCHIf <br /> Location: v <br /> (Best Phys al Description) ZRV Y A or County) Circle One <br /> Date of Discharge: ( "cAIA� <br /> Date Notified: z— .- Time: / '/ 9 Prl <br /> D. RESPONSIBLE PERSON/BUSINESS, <br /> Name of Business: u� ��a) co -- <br /> Contact Person: Telephone: C - 0-X-4, -- <br /> Physical Address: <br /> Mailing Address: �� !3 v a 3 ��. l iu• CA- S o z o Z —603 <br /> E. DESCRIPTION <br /> Type of Discharge: g- - <br /> Volume: <br /> Chemicals: <br /> Circumstances: 1= <br /> ��"k'' <br /> F. ACTION TAKEN <br /> r= <br /> SITE DISPOSITION— <br /> EH 22 013 (Rev.4/91) <br />