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0 SAN JOAQUN COUNTY' 0 FILE COPY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCELARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG r 0 <br /> (Circle one) <br /> B. SOURCE OF INFORMATION <br /> Name: —Phone: 9b?) Rl lo� 3 <br /> Company: <br /> Address: <br /> Designated Employee dame: Phone: — <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCIiaRGE <br /> Location: 44/) 7 E W G_,tDc�•��„���` <br /> (Best Physical Description) (City o County Circle one <br /> Date of Discharge: 4L4 <br /> Date Notified: Time: /,A : 0O <br /> D. RESPONSIBLE PERSONB[;SNESS R J <br /> Name of Business: CRNI FS ��ENER- 1_`�_�tDY <br /> Contact Person:� w)'•F C ��^^^ > �� // ��'� Phone: ( R 9_� 1 —�, 50 <br /> Physical .address' �f 5�D L- !r'd 1/� .qD / `C <br /> Mailing .address: <br /> E. DESCRIPTION <br /> Type of Discharge: 6l„A P <br /> Volume: <br /> Chemicals: <br /> C ircumstances: <br /> reviC&o D _ <br /> F. ACTION TAKEN <br /> SITE DISPOSITION <br /> —ta <br /> EH 22 0 t3 (Rev.. 03/10/98) <br />