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..- <br /> SAN JOAQUIN COUNTY <br /> NOTIFI ON OF HAZARDOUS WASTE DIGIGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVELZie <br /> I III PHS-EH LOG # y 3 - V3 <br /> One) <br /> B. SOURCE OF INFORMATION <br /> Name:_ b AV Q -r- W r4 ch-jr- t Phone: <br /> Company: nh t--rAiT 47 A` Epi i _ <br /> Address: I'A R- L �3 <br /> Designated Employee Name: iAr"I �`c v Phone: -3 10 <br /> Reporting Agency Name: 11c - <br /> Address: r o S <br /> C. LOCATION AND DATE OF DIWCHARGE -61 <br /> Ix2v Location: Lf S- Il &j /=d& g�+ <br /> (Best Physi ' don) (City or Co ) Circle One <br /> Date of Discharge: -?wIn 0 w P-d <br /> Date Notified: -7 7A- -13 Time: S : vo A-r-n <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: <br /> Contact Person: Telephone:. ' / el 4-7,- 4 3 FS— <br /> Physical Address: o AeA U- o <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: <br /> Chemicals: e l <br /> Circumstances: FA <br /> F. ACTION TAKEN <br /> s <br /> SITE DISPOSITION - Se <br /> to e- <br /> 0 <br /> 1:11 22 013 (Rev.4/91) <br />