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r" <br /> � o <br />■'*"� SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGF, <br /> HEALTH & SAFETY CODE 25180.7 /—� �tt F <br /> A. EMERGENCY LEVEL:-II III PHS-EH LOG f V <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: "lPhone: S10 .505.0722 <br /> Company: <br /> Address: jl 4-x 7 <br /> Deignated Employee Name: Phone: �) <br /> Rtpong Agency Naive• <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 3' W <br /> (Best Physical Descrip n) (City r County) Circle One <br /> Date of Discharge; <br /> Date Notified: -/Z 73 Tune: 8d+c <br /> D. RESPONSIBLE PERSO /BUSINESS, <br /> Name of Business: �cr -- <br /> Contact Person: Tel ' hone: <br /> Phy 1qd Address: If lebaxsU4 <br /> Mailing Address:• P64 <br /> E. DESCRIPTION <br /> Type of Discharge <br /> Volume: ' <br /> Chemicals: <br /> Circumstances: <br /> 3 <br /> F. ACTION TAKEN Gam. <br /> C Qo <br /> 7 �- <br /> SITE DISP SMON <br /> 3 ,CA-40!44e 44 <br /> EH 22 013 (Rnv.4/91) 0 <br />