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SAN JOAQUIN COUNTY <br /> D ICATION OF HAZARDOUS WASTE DISCHARGE <br /> CA HEAI,, 1r� & SAFETY CODE 25180.7 <br /> ave <br /> A. EME ENCY L VEL: IT <br /> III EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: onv�a . Se 4v,, Phone: 01) <br /> Company: r-a <br /> Address:_ <br /> Designated Employee Name. Phone: �) <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE O�DISCHARGE <br /> Location:_ y a 1 / � <br /> (Best Physical Description-) (City or ounty Circle One <br /> Date of Discharge: <br /> Date Notified: �S 0 Time: 1 : D a OLe <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: Er <br /> Contact Person: � ,� K <br /> Physical Address: 0 t cJ a K oo Telephone: (_) <br /> Mailing Address: cr <br /> E. DESCRIPTION <br /> Type of Discharge: L�k <br /> Volume: w <br /> Chemicals: <br /> Circumstances: v I <br /> h b-� �� nJ��dr�iv� ScSSM <br /> F. ACTION TAKEN_ <br /> SITE DISPOSITION <br /> EH 22 013 (Rev.4/91) <br />