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A. <br />C <br />Is] <br />E <br />F <br />9 SAN JOAQUI'i t COUNTY is <br />��� E <br />COPY <br />NOTIFICATION OF HAZARDOUS WASTE DISC <br />HEALTH & SAFETY CODE 25180.7 <br />EMERGENCY LEVELI I III PHS -EH LOG # � l - 14a <br />cle one) <br />SOURCE OF INFORMATION <br />Name: H V <br />Company. <br />Address: <br />I' • f /�. � ii./i <br />Designated Employee Name: <br />Reporting Agency Name:_ <br />Address: <br />LOCATION AND DATE OF DISCHARGE <br />Location: i� S %i� �U �� �0 S� / S��-�1 <br />(Best PhvsjcaalDe�cription) iry or County) Circle one <br />Date of Discharge: �� PyVVA <br />Date Notified: U ITime: �I (VI <br />2� <br />RESPONSIBLE PERSON/BUSINESS <br />Name of Business: <br />-C -,ICA <br />Contact Person: �G/ IVB Vel ICy1/CX- ✓ Phone:ZQ — 5Zl <br />Phvsical Address: <br />Mailing Address:GMC ; «G <br />OuP <br />DESCRIPTION <br />Type of Discharge <br />V <br />C. <br />C <br />ACTION TAKEN 1OAA V-� W e VV 1--OMD\/P a 0 n LO l (0 <br />EH 22 013 (Rev. 08/20/98) <br />