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SAN JOAQ UIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 [� <br /> A. EMERGENCY LEVEL: II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Phone: <br /> Name: <br /> (� <br /> Company: <br /> Address: <br /> Designated Employee Name: Phone: <br /> Reporting Agency Name: X <br /> Address:-30Z-° <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: Z70/ AL /- b,da•p.. �� <br /> (Best Physical D scription) ty r County) Circle One <br /> Date of Discharge: <br /> v�wv�ash <br /> g — Time: =� Pal <br /> Date Notified: S� /S�., <br /> D. RESPONSIBLE PERSON USINES <br /> Name of Business: <br /> Contact Person: s Telephone: LVO) ',777—Z-3,// <br /> Physical Address: D - 3 <br /> Mailing Address: !W. 0. &o g CA v3_ D <br /> E. DESCRIPTION <br /> Type of Dischar e. 'A G.&��t7L J id°Aa-•-- <br /> Volume: kAAR,1 V1 . <br /> Chemicals: -eo <br /> MA- <br /> Circumstances: <br /> F. ACTION TAKEN ��.u�ik.y �t -' e �2 e1a�w .�-��• <br /> SITE DISPOSITION <br /> EH 22 013 (Rev.4/91) <br />