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r SAN JOAQUIN COUNTY i <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH& SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL I I III PHS-EH LOG # �l!/ Lif <br /> C ' cle One) <br /> B. SOURCE OF INFgRMATION - <br /> Name: L Phone: <br /> Compan <br /> Address: <br /> Designated Employee Name: Phone: <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISC GE <br /> Location: <br /> (Best Physical description) (City or U Circle One <br /> Date of Discharge- E,L+�- .Cf <br /> Date Notified: I e.- q IG r� . ._ Time: 4�-ov <br /> I <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business•. L 9 tC <br /> Contact Person: t�r�A c�-A M r,..,, yk—) _ Telephone: g,=) 7�z, q- 2,-? <br /> Physical Address: 'VW <br /> Mailing Address: ' _ ( q z T ta'- CA �s C 8-� -...,,.. <br /> E. DESCRIPTION <br /> Type of Discharge: u�J <br /> Volume: Ih � <br /> Chemicals: _ � )� <br /> Circumstanc s: Ln—,V; ,iU" <br /> F. ACTION TAKEN -4-t-Lk LA� <br /> SITE DISPOSITION �vt <br /> ��4 <br /> - Y <br /> 1 <br /> EH 22 013 (Rev.4/91) <br />