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.+..ii.cuua tn:n/ Lby4683o '4 FIFTH FLOOR PAGE 02 <br /> SAN JOAQUEN COUNTY RECENED <br /> NOTIFICATION OF EI.AZARDOUS WASTE DISCEL�RGE <br /> EIEaLTII & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I lI III PHS-EH LOGO �— 1 <br /> (Circle one) <br /> B. SOURCE OF INFOILMA.TION <br /> Name, Phone: (27) 442 7P(�(7 <br /> Comp , ITS <br /> Address: <br /> Designated Employee Name: Phone: <br /> _ Repotting Agency Name: <br /> Address: <br /> C. LOCATION,,ND DATE OF DISCHARGE <br /> z S > ,suis <br /> Location: �� �' I <br /> (Best Physical Description) (City or ouatvJ ircleone <br /> Dare of Discharge: rune <br /> Date Notified: M. <br /> w 7 _ <br /> D. RESPONSIBLE PERSONIBUSINESS <br /> Name of Business: <br /> Contact Person: Phone: <br /> Physical Address <br /> Mailing address: <br /> E. DESCRJPTION <br /> Type of Discharge; <br /> Volume: <br /> Chemicals: <br /> Circumstances: <br /> F. ACTION T- IDES ,�. eMw <br /> E <br /> _ ex�b uu.c. Oso <br /> DISPO�S SON Q u4,4 C., <br /> Qr- ✓ t� <br /> 1 <br /> EH 22 013 (Rev,03120/98) <br />