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S`7'liN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE O T <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: III III <br /> PHS-EH LOG A-2 <br /> ( ' cle One) <br /> B. SOURCE OF INFORMATION <br /> Name: (.!onone Phone: , <br /> Company: CPQ b2 70 <br /> Address: Phone: (__._) <br /> Designated Employee Name: <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION NATE OF DISC CCH G <br /> Location r County) Circle One <br /> (Best Physical De tiot) <br /> Date of Discharge: <br /> Date Notified: Ila —l � — Time: <br /> D. RESPONSIBLE PERSONINE S . <br /> Name of Business: — Z <br /> Contact Person: Telephone: CAD <br /> Physical Address: DK 9 <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Disch e: Q <br /> Volume: i) ?, <br /> Chemicals: a- vG <br /> 275 <br /> C' tances• <br /> F. ACTIO T N /P- <br /> 4 <br /> SITE DISPOSITION <br /> EH 22 013 (Rev-4/91) <br />