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SAN JOAQUIN COUNTY < ' <br /> NOTIFI`�." FION OF HAZARDOUS WASTE DIS"!rIARGE <br /> HEALTH & SAFETY CODE 25180.7 C O py <br /> A. EMERGENCY LEVEL: ID II III <br /> PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION Phone: (2& y��3�lbd <br /> Name: / o Z— Ile 5o - Pud!« /leo //� Se �,�P <br /> Address: 9SZo <br /> Designated Employee Name: Phone: (22�) VC 3vbd <br /> Reporting Agency Name: S5�pqs <br /> Address: L/ys` .� .-S <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: id S7 fo�� `� / G " ` <br /> (Best Physical Description) ry r County) Circle One <br /> Date of Discharge: <br /> Date Notified: 7-d-g i Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: a /-�v.eo A-- <br /> Contact Person: „ / /v, // Gms Telephone: f,?22) S,33 <br /> Physical Address: /e c4 9 Y r <br /> Mailing Address: _ rr> va 9sab <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: C n inv <br /> Chemicals: lel2ze34 e <br /> Circumstances: -7-,.,/�FCi , 2 SLvi h-er__�v <br /> Ay Ole <br /> F. ACTION TAKEN <br /> 6 .� or �/ yr/i � � � /o�rG �lifz' � re Fob= 4 G� l�•c�.-0 <br /> -ITE DISPOSITION / <br /> SWEEPS/SITE CODE <br /> EH 22 013 (Rev.4/91) CONT. MFR: © / N <br /> REFERRAL TO: <br />