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SAN JOAQUIN COUNTY ' L' <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE ^ D <br /> HEALTH & SAFETY CODE 25180.7 ( j <br /> A. EMERGENCY LEVEL: TDII III PHS-EH LOG #_ <br /> (Circle One) <br /> B. SOURCE OF INFO <br /> Name: ---; � Phone: *68-0 33 5 <br /> Company: .SZ-- Zo- ?A)s- E7 <br /> 5 <br /> Address: <br /> Designated Employee Name: Phone: (_) <br /> Reporting Agency Name: <br /> Address: 30 ,E. rnwek3w:;"-O Ave. <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: Z-36 4AI"-I t o A6 / Lodz <br /> (Best Physical Des 'ptio ) (mor County) Circle One <br /> Date of Discharge: k-d 'IT <br /> Date Notified: Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: <br /> Contact Person:- Telephone: So YY 2 - g52F1 <br /> Physical Address: <br /> Mailing Address: P o <br /> E. DESCRIPTION <br /> Type of Disch ge: <br /> Volume: <br /> Chemicals: <br /> Circumstances: <br /> F. ACTIONTAKEN Qj 4r11;D,l9Z <br /> SITE//DISPOSITIONg, <br /> EH 22 013 (Rev.4/91) <br />