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e <br />0 <br />SAN JOAQUIN COUNTY D <br />NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br />HEALTH & SAFETY CODE 25180.7 <br />EMERGENCY LEVEL: III III PHS -EH LOG # / <br />(Circle One) <br />SOURCE OF INFORMATION <br />Name: <br />Company: <br />Address: <br />Designated Employee Name: <br />Reporting Agency Name: <br />Address: *51S Al. <br />C. LOCATION AND DATE OF DISCHARGE <br />F. <br />Phone: 2n) ".?- o33� <br />Phone: �) <br />2'4> <br />Location: ffl?b «ate / L-04a:�,— <br />(Best Physical pti ) ( County) Circle One <br />Date of Discharge: NWQ� � <br />Date Notified: 7,16 5' Time: <br />RESPONSIBLE PERSON/BUSINESS <br />Name of Business: S4 <br />Contact Person: <br />Physical Address: / '2,qO <br />Mailing Address: <br />DESCRIPTION <br />Type of Discharge- <br />Volume: eQ a <br />Chemicals: GsQSaG.r, -t_ <br />Circumstances: ®f3sra2tp9�rr�ei S <br />r <br />Telephone: s<o <br />EH 22 013 (Rev -4/91) <br />