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• SAN JOAQUIN COUNTY • D <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVELII III PHS-EH LOG # <br /> ( ircle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Phone: L_j <br /> Company: <br /> Address: <br /> Designated Employee Name: Phone: <br /> Reporting Agency Name: e . _ A rv+n.w. Ewl 1 <br /> Address: 60L. <br /> C. LOCATION AND DATE OF DI CHARGE <br /> Location:JL <br /> (Best Physical Description) Ci or County) Circle One <br /> Date of Discharge: a ",Xwrt m <br /> Date Notified: /r�� .44 Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: _ r a eco -27,e- A-�A <br /> Contact Person: d✓- A/. ,,-r--/za v Telephone: <br /> Physical Address: <br /> Mailing Address: e2 l z.W <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: U v,�,nj. ,i <br /> Chemicals: �Dredr-f <br /> Circumstances: �Q A^w> k �� �.s� 04. u� a � <br /> F. ACTION TAKEN ��n c S r 1 -��c. �t� re�w�7L. <br /> SITE STATUS P,,0i. , ,¢ G <br /> EH 22 013 (Rev.4/91) <br />