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� SAN JOAQU[N COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE, <br /> HEALTH & SAFETY CODE 25180.7 <br /> Cr r <br /> A. EMERGENCY LEVELO II [II PHS-EH LOG A211 <br /> (Circle One) <br /> B. SOURCE OF INFORMATIOQ y phone s�o bYb - 4600 <br /> Name: 3 u G / l!�� /6 <br /> Company: <br /> Address: r s vo r3�4-1 A i s ro j A j rA 9 -r S tv <br /> Designated Employee Name: .� r) Phone: (20J4�Y 34 (C <br /> Reporting Agency Name: <br /> Address: 5A-k- E - r 4 'f-x <br /> C. LOCATION AND DATE OF DISCHARGEoc� <br /> Location: g 7 3 S i PP & �r <br /> (Best Physical Description ry cle One <br /> Date of Discharge: <br /> Date Notified: ii/ /'f T• <br /> D. RESPONSIBLE PERSON/BUSINESS _ <br /> Name of Business: �2>0 e <br /> 20 k Tele yLy - s ti <br /> Contact Person: hone: v p <br /> Physical Address: P v R ox z o 0 3 , c, n G9 ?sd! 3 — <br /> Mailing Address: . <br /> E. DESCRIPTION <br /> Type of Discharge: 4,1 <br /> Volume: 0w w <br /> Chemicals: u S a <br /> Circumstances: <br /> F. ACTION TAKEN (,Z64 <br /> SITE DISPOSITION i lGw s%Lr <br /> •f- et linkr /,z <br /> lc-%rn 4<.lnr�r l Ti ,L r �.i� s t! n/o rrr r .�ettcc• <br /> EH 22 013 (Rev.4/91) O <br />