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i <br /> 0 <br /> SAN JOAQUIN COUNTY �) [—DIV <br /> ,NOTIFICATION OF HAZARDOUS WASTE DISCHARGE � <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:C II III PHS-EH LOG # 7 (�� f7 <br /> (Circle One) <br /> B. SOURCE OF INFORMATION I <br /> Name: f-ruLLa, DES Phone: <br /> Company: <br /> Address: <br /> Designated Employee Name: Phone: <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: rL)w (H - / <br /> (Best Physical scr. tion) (City ori unty Circle One <br /> Date of Discharge- t !�f) --- <br /> Date Notified: Time: <br /> D. RESPONSIBLE PERSRN/BUSI ESS ' <br /> Name of Business: fC�,� Gvt,-0A-r <br /> Contact Person: , ,, tom• -U- Telephone: (Zgj F?h- Of 6 <br /> Physical Address: �, mi <br /> Mailing Address: Cl- C6:� Sd I—A(, u CN Sr 1 <br /> J <br /> E. DESCRIPTION <br /> Type of Discharge: o <br /> Volume: U LU <br /> Chemicals: <br /> Circumstances: <br /> Gut<72 <br /> F. ACTION TAKEN -� .a <br /> TE sy <br /> NZl L <br /> EH 22 013 (Rev.4/91) <br />