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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 D <br /> A. EMERGENCY LEVEL:CDI[ [II PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Phone: L� <br /> Company: -Sco SiQC 2,,-5PA-rr—� <br /> Address: <br /> Designated Employee Name: Phone: L� <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 410 <br /> (Best Physical Des nption) �iIoor County) Circle One <br /> Date of Discharge: R <br /> Date Notified: 8 96 Time: 5,,Zo ce- <br /> -� r <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: <br /> Contact Person: r o C Telephone: L—) <br /> Physical Address: <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discl argF: c <br /> Volume: <br /> Chemicals: —ate fiE / <br /> Circumstances: ids - <br /> C-a �r/lE /�iSPF�TG <br /> F. ACTION TAKEN 0/Sgwc,416, E r,45 O�,– <br /> SITE STATUS 7-D Ilk Al—c <br /> — <br /> cz,6 <br /> EH 22 013 (Rev.4/91) <br />