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SAN JOAQUIN COUNTY e" ewae <br />NOM _tTION OF HAZARDOUS WASTE D, HARGE <br />HEALTH & SAFETY CODE 25180.7 FD -)y <br />A. EMERGENCY LEVEL: a n III PHS -EH LOG # v/ �� ✓ <br />(Circle One) <br />B. SOURCE OF INFORMATION <br />Name: AL. K- o <br />Phone: E±2 LS - ?y a <br />Company: n. <br />Address: V, . OX �, o T -- <br />Designated Employee Name: <br />Designated <br />Phone: (�) <br />Reporting Agency Name: <br />Address: <br />C. LOCATION .-AdND DATE OF DISCHARGE <br />Location: tLA-14� <br />/ C9 <br />(Best Physical qes� 'tion) <br />or County) Circle One <br />Date of Discharge: <br />Date Notified: I2J;Tqi <br />Time: -3:0p- <br />'t <br />D. RESPONSIBLE PERSON/BUSINESS <br />Name of Business: 5olu4 <br />Contact Person: 0e -c <br />Telephone: fv36� -37.bV <br />Physical Address: ;-0,S-06 <br />eA:. <br />Mailing Address: U. 3zW bo Ti�!�,, <br />E. DESCRIPTION <br />Type of Discharge: S <br />Volume: <br />Chemicals: Z <br />Circumstances: Dw <br />Fa <br />n <br />c <br />EH 22 01%(v.4/91) <br />