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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH &. SAFETY CODE 23180.7 <br /> A. EMERGENCY LEVEL II III PHS-EH LOG <br /> (Circle one) <br /> B. SOURCE OF INFORNL4TION <br /> Name: <br /> Phone: (V 993- '795 _ <br /> Company: ✓ S — j <br /> Address: t'1 I <br /> Designated Employee Name: it 1 ✓l G( Phone: $— <br /> Reporting Agency�Name: { !ir L Lits LU)- - <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 2.. W. Szywtn IsMe& / <br /> (Best Physical Description) t r County) Circle one <br /> Date of Discharge: <br /> Date Notified: 1 Time:,. $',30��1 <br /> D. RESPONSIBLE PERSONIBUSINESS <br /> Name of Business: SDLLM <br /> Phone: o�Q%- $3Ci—fr33a <br /> Contact Person: CJl >3 <br /> Physical Address: I <br /> Mailing Address: D- <br /> E. DESCRIPTION <br /> Type of Discharge: ~ <br /> Volume: P4�:Q-- <br /> M <br /> Chemicals: 2 <br /> Circumstances: <br /> COLO <br /> F. ACTION TAKEN 'rGLV��Gs r <br /> Y' <br /> SITE DISPOSITION 1,r 4 V f <br /> EH 22 013 (Rev. 08120199) <br />