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15 <br />SAN JOAQUIN COUNTY 0 <br />NOTIFICATION OF HAZARDOUS WASTE DISCHARGE fCD) <br />HEALTH & SAFETY CODE 25180.7 <br />A. EMERGENCY LEVE I II III PHS -EH LOG # <br />ircle One) <br />B. SOURCE OF INFORMATION <br />Name: Phone: �) <br />Company: <br />Address: <br />Designated Employee Name: /91C4L/ &L r, i D3- Phone: zc ) -3 <br />Reporting Agency Name: <br />Address:, s_ ,,/c-� <br />C. LOCATION AND DATE OF DISCHARGE <br />0 <br />E. <br />Location: � 34-, arnmug QLPjp&�„te -0 <br />(Best Physical Description) Ci r County) Circle One <br />Date of Discharge: Ku 4,yU.i . <br />Date Notified: - s- -� .� Time: Z : ou QPM <br />RESPONSIBLE PERSON/BUSINESS <br />Name of Busine: <br />Contact Person: <br />Physical Address <br />Mailing Address: <br />i67�Y : 2-0001 <br />SITE DISPOSITION 7),= <br />EH 22 013 (Rev.4/91) <br />