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• SAN JOAQUIN COUNTY • <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:' Ir II III PHS-EH LOG # q3 -0-77 <br /> ( cle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Dorao, prllPhone: OeD7--41 D <br /> Company: <br /> Address: <br /> Designated Employee Name: Phone: C <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATIO D DA{�TE^OF D SCHARGE <br /> I LL <br /> Location: i { 'f-Z / TDA <br /> (Best Physical Description) Ci County) Circle One <br /> Date of Discharge: <br /> Date Notified: Time: '44 <br /> D. RESPONSIBLE PERSON USINE <br /> Name of Business• G <br /> Contact Person: Telephone: LZO� 5l6 -Z z <br /> Physical Address: 97e-1CA- -l520 <br /> Mailing Address: SG -e- <br /> E. DESCRIPTION <br /> Type of Discharge: �4Q Kin l/J� <br /> Volume: Z � <br /> Chemicals: <br /> C' cumstances: <br /> F. ACTION TAKEN <br /> SqE DISPOSITION a Z/ <br /> EH 22 013 (Rev.4/91) <br />