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'' SAN JOAQUIN COUNTY ' <br /> NOTIFIC. -ON OF HAZARDOUS WASTE DIS: A .G J <br /> r.A.LTH & SAFETY CODE 25380.7 ;(`�'` <br /> V <br /> A. EMERGENCY LEVEL:� iI III PHS•EH LOG <br /> (Circle One) �r <br /> B. SOURCE OF INFORMATION <br /> 71,?-7 Phone: L2'D f3-- 3 1/6 <br /> Company:_ rvt <br /> Address:_=- /.?- <br /> Designated <br /> 1.?-Designated Employee Name: Phone: (. „} <br /> Reporting Agency Name: <br /> Address: <br /> I� <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: <br /> (Best Physical Description) (City or unty Circle One <br /> Date of Discharge: <br /> Date Notified: /X/.'/9 % _._ Time: 6--44 ,e <br /> } <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: f;ring b et s r rl e s-5 (0a <br /> Contact Person:- By Telephone! uq e,7 , <br /> Physical Address: ?1-7,) <br /> Mailing Address: r. L <br /> E. DESCRIPTION <br /> Type of Discharger <br /> Volume: <br /> Chemicals: <br /> Circumstances: <br /> LjF. ACTION TAKEN <br /> SITE DISPOSITION G.", •✓'e� <br /> I' ✓�L <br /> v <br /> I <br /> I <br /> EH 22 013 (Rev.4/91) <br />