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SAN JOAQUIN COUNTY n� <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARC <br /> HEALTH & SAFETY CODE 25180.7 u ((JJ <br /> A. EMERGENCY LEVEWrele <br /> III PHS-EH LOG <br /> one) <br /> B. SOURCE OF INFORMATION <br /> Name: PeC Phan <br /> Company: <br /> Address: p S S <br /> Designated Employee Name: Phone:o2p9!/ .�yS <br /> Reporting Agency Name: SIG <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: VSlb &a. CtZCe� <br /> (Best Phys,CalOpscription) Ci r County) Circle one <br /> Date of Discharge: 0 <br /> Date Notified:_ /�/�2 � <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: <br /> Contact Person: Phone: 3� <br /> Phvsical Address: <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: <br /> Chemicals: <br /> Circumstances: i JJ <br /> F. ACTION TAKEN <br /> SITE DISPOSITION ✓J/> <br /> EH 22 013 (Rev. 08/20/98) <br />