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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> 'T <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG # <br /> ( ircle One) <br /> B. SOURCE OF INFORMATION _ <br /> Name: R, Phone: <br /> Company: E i2M bv.tI�A <br /> Address: 11TZ f�nf-� ' o bAku -z- <br /> Designated Employee Name: Phone: �) <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE,OF DISCHARGE <br /> Location: <br /> (Best Physical Descript on) (City or�ntyY Circle One <br /> Date of Discharge- <br /> Date Notified: 'Y - j ct s Time: <br /> D. RESPONSIBLE PERSQN/BUSINESS <br /> Name of Business: <br /> Contact Person: Telephone: e 3 S �f i> <br /> Physical Address: 5/4 <br /> Mailing Address: VA <br /> E. DESCRIPTION <br /> Type of Discharge: r,2 .0 <br /> Volume: <br /> Chemicals: jaLA t d-Co Ccs-a <br /> Circumstan es: C /'moi-n <br /> F. ACTION TAKEN <br /> SITE STATUS <br /> � 0 <br /> EH 22 013 (Rev.4/91) <br />