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A. <br />C. <br />F&I <br />F. <br />zzj.. <br />SAN JOAQUIN COUNTY <br />NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br />HEALTH & SAFETY CODE 25180.7 <br />D <br /># <br />EMERGENCY LEVEL: 0 11 111 PHS -EH LOG Rff /:5— <br />(Circle One) <br />SOURCE OF INFORMATION <br />Name: <br />.501 <br />OWN <br />0 <br />Designated Employee Name: Phone: <br />Reporting Agency Name: <br />Address: <br />LOCATION AND DATE OF DISCHARGE <br />Location: If05 Al <br />(Best Physical Description) <br />Date of Discharge: -ze�c,1c�c�p.ur <br />Date Notified: , A 0 . /5 <br />RESPONSIBLE <br />Name of BusinE <br />Contact Person: <br />Physical Addres <br />Mailing Addres-, <br />City or County) Circle One <br />Time: <br />DESCRIPTION <br />Type of Discharge: <br />Volume: <br />Chemicals- /2— <br />Circumstances: Z <br />EH 22 013 (Rev.4/91) <br />