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Lu: <br /> '�✓ SAN JOAQUIN COUNTY l <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II III <br /> S-EH LOG # , <br /> (Circle One) (C 00 <br /> B. SOURCE OF INFORMATION /r <br /> Name: Phone: (Z[IJ, <br /> Company: <br /> Address <br /> Designated Employee Name: f,4; e5 Phone: `% <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: a l�J / C,- <br /> (Best Physical Description) (City o ounty Circle One <br /> Date of Discharge: <br /> Date Notified: I - ;?L,- 9 Time: f/ 0 c cz,m- <br /> D. RESPONSIBLE PERSON/BUS2LL <br /> _Name of Business: , L s <br /> Contact Person: •+ Telephone: (Y10.6, -f?7 / <br /> Physical Address: <br /> Mailing Address: I t . <br /> E. DESCRIPTION _ <br /> Type of Discharge: ZZ 4 R <br /> Volume: <br /> Chemicals• _ <br /> Circumstances: <br /> J <br /> F. ACTION TAKEN 0-,- <br /> SITE <br /> SITE DISPOSITION c . � <br /> (ezy ' <br /> EH 22 013 (Rev.4/91) <br />