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•SAN JOAQUIN COUNTY • <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE C- <br /> HEALTH <br /> �/& SAFETY CODE 25180.7 `J ��-•-� <br /> iU L! Ll <br /> A. EMERGENCY LEVFLO II III PHS-EH LOG # <br /> - D/s <br /> (Circle One) <br /> B. SOURCE OF INFORMATION phone: (200 <br /> Name: ,Eo le <br /> Company: OUPC',t - <br /> Address: <br /> Designated Employee Name: (' .L Phone: ( ygoy 3 { <br /> Reporting Agency Name: S -r�� G C, ' 71,1 c <br /> Address: W5- A2S ova u. �' T S�o� E Grw , c t�c 4 <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: Q() cJ Cl z� City o County) Circle One <br /> (Best Physical Description) <br /> Date of Discharge: ,•%�� 3 - <br /> Date Notified: -;�,/y/93 Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: 4 �vez4l <br /> Contact Person //9/y Telephone: (2�f)�— <br /> Physical Address: -,Fi9V ' ' ' <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: <br /> Chemicals: <br /> Circumstances: <br /> -4ir i�e� CaGG¢-P C�T .I7 St�i ivy i.n .�L/c.�✓� >yt)X/� ��i �J �cl <br /> F. ACTION TAKEN /-------------- <br /> SITE DISPOSITION <br /> X / ..l <br /> G' <br /> i <br /> O <br /> EH 22 013 (Rev-4/91) <br />