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jl�-- -0-1- <br /> SAN JOAQUIN COUNTY Is <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE C <br /> V <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: �II III PHS-EH LOG # 3 — / <br /> 25 <br /> (Circle One) <br /> B. SOURCE OF INFORMATION fg—&L-2—w-1 Name: 2 i G k R�, Phone: <br /> Company: L 1- 5 i- <br /> Address: <br /> Designated Employee Name: L Phone: W Z/6 3 a <br /> Reporting Agency Name: <br /> Address: P► B a <br /> C. LOCATION ND DATE OF PISCHARGE <br /> Location•• r f(3 L 2 SJ G <br /> (Best Physical Description) (City or Co ty) Circle One <br /> Date of Discharge: U N V,w <br /> , <br /> Date Notified: !1 -22-q Time: , Ua <br /> D. RESPONSIBLE PERSON/BUSINESS L <br /> Name of Business: & U <br /> Contact on: Telephone: <br /> Physical Address: <br /> M ' ° g Address: f 0i <br /> E. DESCRIPTION � �� ` <br /> Type of Discharge: S.,?k"oc,�:e.J <br /> volume: ��►Kv�crw iJ - <br /> Chemicals: <br /> Circumstances: Q 1 ver o <br /> 1� P <br /> F. ACTION TAKEN 77J-/V & T"®9-z A FfFI, AO)e- <br /> vo,;� <br /> W <br /> .yJ / .4 w <br /> SITE DISPOSITION <br /> d <br /> R, <br /> EH 22 013 (Rev.4/91) <br />