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Y SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SA.FETY CODE 25180.7 <br /> J •\,f <br /> A. EMERGENCY LEVELI I III E `'-P; " F� <br /> H EH LOG # - /)S� <br /> Ircle One) <br /> B. SOURCE OF INFO TION <br /> Name- <br /> --962? Phone: <br /> Company: <br /> Address: d p a-- <br /> Designated Employee Na e: f. soo <br /> Reporting Agency Name- Phone: <br /> Address: <br /> C. LOCATION AND DATE O D cA GE <br /> Location: &/. � <br /> (Best Physical Description) (City or o } Circle One <br /> Date of Discharge: AJ0aA/ <br /> Date Notified: -::F-. 7- 3 Time; D�•� <br /> D. RESPONSIBLE PERSON USINESS <br /> Name of Business: <br /> . Contact Person: ' Telephone: <br /> Physical Address: S 1 oS <br /> Mailing Address: -O_ 6 <br /> E. DESCRIPTION <br /> Type of Discharge: ` <br /> Volume: <br /> Chemicals: ,, y <br /> Circumstances: <br /> F. ACTION TAKEN -- <br /> yb <br /> SITE DISPOSITION — <br /> ZIE j: <br /> • ------------------ <br /> EH 22 013 (Rev.4/91) <br />