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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGC O [pyHEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL• I II III PHS-EH LOG # <br /> Qvle One) <br /> B. SOURCE OF I FORMATION <br /> Name: kec Phone: (� <br /> Company: <br /> Address: D /30� A' 0-3 3' r l-rA r,+ 9 07o Z, <br /> Designated Employee Name: Phone: (_ <br /> Reporting Agency Name: S tee« <br /> Address:_3 T <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 7c^ 17 /,� C/ b -S <br /> (Best Physical Description) or County) Circle One <br /> Date of Discharge: ( AW4,� vi <br /> Date Notified: 's-14 Time: /l a7 R t j <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: vj� <br /> Contact Person: Telephone: !V ) X 70=,4 o� <br /> Physical Address: <br /> Mailing Address: -,P—() R�� �'0�3 Sl /q r "— �� n�o Z <br /> E. DESCRIPTION �/ _ (� <br /> Type of Discharge: 001:1 o r �� e <br /> Volume: (j),a" - <br /> Chemicals: <br /> Circumstances: ti ti ` n P <br /> �` ro <br /> F. ACTION TAKEN <br /> SITE STATUS ^^ <br /> EH 22 013 (Rev.4/91) <br />