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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: if III PHS-EH LOG # <br /> ( ircle One) <br /> B. SOURCE OF INFORMATION <br /> Name:_a?,�17,e-Toc2,1 Phone: /' 7`��-�3 S S <br /> Company: 1i 4L1 use RID <br /> Address: 2-goi k'7 iov <br /> Designated Employee NamPhone: CLe ) V -3 qY Z, <br /> Reporting Agency Name: 1=145 6ff p A <br /> Address:_.o. [3-x Zbo <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: Mitac L/Z). <br /> (Best Physical Description) City County) Circle One <br /> Date of Discharge: _..? -3 Iq r <br /> Date Notified: _ '7/Z 3 f R r „. Time:-// :06 ,4.417. <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: <br /> Contact Person: Dr-- A4,"cr— Telephone: 0-4-1) -oLf� <br /> ` Physical Address: U <br /> Mailing Address:�/ 7 ! �� 2�L �,� i3 <br /> E. DESCRIPTION <br /> Type of Discharge: L6AK <br /> Volume: {5v <br /> Chemicals: <br /> Circumstances: j <br /> F. ACTION TAKEN <br /> SITE DISPOSITION <br /> EH 22 013 (Rev.4/91) <br />