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55 <br /> SAN JOAQUIN COUNTY . <br /> NOI CATION OF HAZARDOUS WASTE�SCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: IDI III PHS-EH LOG <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Q P _,_ Phone: 2� 67o- �04 <br /> Company:_ &g�o l� av�TS G�.yi}9 y <br /> Address: 70z-60 S 7. <br /> Designated Employee Name: Phone:::'( <br /> Reporting Agen Name: <br /> Address: -7 <br /> C. LOCATION AND DAT OF DISCHAR E� <br /> Location: rZ-- L! fY <br /> (Best PhysicalTes 'ptli n) a r County) Circle One <br /> Date of Discharge: ow <br /> Date Notified: 3p Time: w-4 <br /> D. RESPONSIBLE PERSON/BUSINESS " '•; <br /> Name of Business: <br /> Contact Person: Telephone: (Zc-f670 6-5,,104 <br /> Physical Address: -{ <br /> Mailing Address: o. x Go 7-,b-r —7 Fs C4 6z:)7SF_ <br /> E. DESCRIPTION ti <br /> Type of Discharge: <br /> Volume: 1 r �Y- <br /> Chemicals: �ggsrx <br /> Circumstances: �o so.� �'v �•�-�, r s- ,Q <br /> F. ACTION TAKEN <br /> i <br /> i. <br /> SITE DESPOSIT1 N 5r�C .vs r1 G <br /> - 42 <br /> EH 22 013 (Rev.4/91) <br /> a <br />