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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISaIARGE <br /> HEALTH & SAFETY CODE 25180.7 CoFff)), <br /> A EMERGENCY LEVEL: III III PHS-EH LOG # -O 9 3 <br /> (Circle One) <br /> B. SOURCE 9F INFO T10 <br /> Name: ti' { c� (' i 49S Phone: <br /> Company: <br /> Address: <br /> Designated Employee Name: c' Phone: ( � <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: j)t"Ir <br /> (Best Physical Description) (Ci r County) Circle One <br /> Date of Discharge: GG <br /> Date Notified: 06-77- 2/;5, Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: / <br /> Contac Person: E�o Telephone: Q&V 75 9- �Td <br /> Physical Address: <br /> Mailing Address: �? C , �g �' C 55 22,7 <br /> E. DESCRIPTION <br /> Type of Discharge: GL A R 't.- <br /> Volume: <br /> r"Volume: 0-4--t-t2, <br /> Chemicals: T.4ru qt-- I <br /> Circumstances: ,? - <br /> F. ACTION TAKEN77 <br /> *t c <br /> G <br /> SITE DISPOSi 17ON <br /> , - f) P <br /> aL, <br /> L-H 22 013 (Rev.4/91) <br />