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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISL7ARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: E:z4 Qu Phone: S24 277- 23/1 <br /> Company: 4,, CAn <br /> Address: G TE �3 <br /> Designated Employee Name: Phone: L� <br /> Reporting Agency Name: <br /> Address: -5c>cl- Z- -� tiSzo�. <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 1l—u70 <br /> (Best Physical Description) (City or County) CircleOne <br /> e0 <br /> Date of Discharge: <br /> Date Notified: Time: I n!fo l+n-) <br /> D. RESPONSIBLE PERSON/BUSINESS 1 <br /> Name of Business: <br /> Contact Person: Telephone: <br /> Physical Address: 2=0 G2aw Goti�Ga cF �J 4�a5 �w r CA 3 <br /> Mailing Address: <br /> E. DESCRIPTION /� <br /> Type of Discharge: Qcsso\'rz,5— <br /> Volume: <br /> Chemicals: <br /> Circumstances C <br /> F. ACTION TAKEN--is 1- G s lc ccs �iZ� fY n� <br /> SITE DISPOSION 's <br /> EH 22 013 (Rev.4/91) <br />