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SAN JOAQUIN COUNTY j <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL61rcli,e <br /> I III PHS-EH LOG One) <br /> B. SOURCE OF INFORM TION <br /> Name: ,8 Phone: L—) <br /> Company: 071b W51 -Add- `a-c.Q a- <br /> Address: d 10 b 9 500 <br /> Designated Employee Na e: Phone: <br /> Reporting .Agency Name: <br /> Address: <br /> C. LOCATION AND DATE O DISCHARGE / <br /> Location: 6j��Z !�(/- Dcl .c.2 / �do <br /> (Best Physical Description) (City or o ) Circle One <br /> Date of Discharge: Llin- 4JOaMl <br /> Date Notified: S 7-Q3 T ime: l0 <br /> D. RESPONSIBLE PERSON g USINESS <br /> Name of Business: <br /> Contact Person: _ O-L*• Telephone: <br /> Physical Address: $ J &A a� <br /> Mailing Address: -D . l��t_ �'ic 3Q3 <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: <br /> Chemicals: o-z T <br /> Circumstances: <br /> F. ACTION TAKEN <br /> SITE DIS:OSIT!ON — �t<d> <br /> EH 22 013 (Rev.4/91) <br />