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1 <br /> SAN JOAQUIN COUNTY <br /> NOTIFizATION OF HAZARDOUS WASTE Dr CHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG # / 7 -O�� <br /> (Ciircle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Ste- 1 a Phone: <br /> Company: Cbz <br /> Address: a8� E r Sit <br /> Designated Employee Name: a Phone: <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: a l S i <br /> (Best Physical Descrip ' n) (City or otm Circle One <br /> Date of Discharge: i (� _12��� w� <br /> Date Notified: _ 1 - /9- 5 c( Time: lo ,.30 <br /> D. RESPONSIBLE PERSO BUS NESS <br /> Name of Business: <br /> Contact Person: Telephone: (,;on <br /> Physical Address: a� <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: ""— <br /> Chemicals: <br /> Circumstances: <br /> 9 S <br /> F. ACTION TAKEN_ <br /> SITE DISPOSITION !/fIP C� - �� <br /> EH 22 013 (Rev-4/91) <br />