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0 SAN JOAQUIN COUNTY 0 <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> FILECOPY HEALTH & SAFETY CODE 25180.7 <br /> A EMERGENCY LEVELII III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATI <br /> " Phone: <br /> Name: L� 5�7-63yC <br /> Company: <br /> Address: AG <br /> Designated Employee Nam6: P one: <br /> Reporting Agency Name: <br /> Address: .s0�'f- <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: Sob D' /c ^ lCu/cd] <br /> (Best Physical Descriptio 61W-=County) Circle One <br /> Date of Discharge: //y �vA rn <br /> Date Notified: Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: AfW <br /> Contact Person: 421 "lc Telephone: ?/�" 177--03Y� <br /> Physical Address: 36d-e Fa /Ci214 f <br /> Mailing Address: <br /> E. DESCRIPTION , <br /> Type of Dis oe: j '4,' <br /> Volume: 1127C <br /> Chemicals: <br /> Circumstances: 1:>Sc C <br /> F. ACTION TAKEN ✓� <br /> SITE STATUS / !a /n �✓l'ati. fyhrni 22 SV <br /> EH 22 013 (Rev-4/91) <br />