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5-15-1998 7:58AM FROM' P. 2 <br /> f t <br /> SAN JOAQUIN COUrny MAY ! 5 �`7 8 <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:-1 III PHS-EH LOG # q O� <br /> (Coale One) <br /> B. SOURCE OF INFORMATION <br /> Name: Phone: (_) <br /> Company: <br /> Address: <br /> Designated Employee NarrigPhone: <br /> Reporting Agency Name:---'wK <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE / ? <br /> Location: Fr tt v o !Mt /,Jwty�- 14K&. c ; {JEk—+* <br /> (Best Physical Description) l (tCity r County) Circle One <br /> Date of Discharge: Sal L Y <br /> Date Notified: _�j z--4„ _ Time: 12� eP r(. <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business i <br /> Contact Person: Tel hone: (�) - <br /> Physical Address: I Z-S'!/v 0 Z o f CA 4 <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: <br /> Chemicals: <br /> Circumstan <br /> F. ACTION TAKEN „++-+. <br /> SITE DISPOSITION <br /> EH 22 013 (Rev.4/91) <br />