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SAN JOAQUIN COUNTY / <br />NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br />HEALTH & SAFETY CODE 25180.7 <br />0-�;P <br />A. EMERGENCY LEVELI II III <br />cle One) <br />B. SOURCE OF I1�FORMATION <br />Name: Hi'il2u/v Horrl-ll <br />PHS -EH LOG # ��2 , 21 b <br />Phone: (ZDl Z698'�,4Zi <br />Address: Z52 -'T FlES no 5trz2t / r.0 sax 11 7 / <br />Designated Employee Name: Phone: <br />Reporting Agency Name: <br />Address: <br />C. LOCATION AND DATE OF <br />0 <br />E. <br />IV <br />(Best Physical Description) <br />Date of Discharge: IKw n <br />Date Notified: IU -Z9-9 2 <br />RESPONSIBLE <br />Name of Businc <br />Contact Person. <br />Physical Addre: <br />Mailing Address: <br />/ 5%ck-fes <br />(City r County) Circle One <br />DESCRIPTION <br />Type of Discharge: <br />EH 22 013 (Rev.4/91) Q <br />