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SAN JOAQL rLN COL---,TY -- FILE COPY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SA.FETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: II III <br /> PHS-EH LOG T 00 - 09S <br /> (Circle one) <br /> B. SOURCE OF INFOfNMATION <br /> Phone: ( } <br /> Name: <br /> Company: <br /> Address: C <br /> Designated Emplovee dame: Phone: <br /> Reporting Agency Name: <br /> :address: <br /> C. LOCATION AND DATE OF DISCH_-kRGE <br /> Location: �'1 ! -S Lo Gf��- <br /> (Best Physical Description) ire' rlcounvv) Circle one <br /> Date of Discharge: <br /> Date Notified: Time: <br /> _ /, J' ��F' �— - <br /> D. RESPONSIBLE PERSONIBUSNESS <br /> dame of Business: _77 ,11- _ <br /> Contact Person: _ <br /> Phone: D <br /> Physical address: C � <br /> ivlailing Address: O <br /> E. DESCRIPTION <br /> Tvpe of Discharge: , <br /> Volume: ��v <br /> Chemicals: �' 11 <br /> C ircumstanct!s: <br /> 9f <br /> 44-1 <br /> F. AC ION T.-�KEN Q w <br /> �L o <br /> SITE DISPOSI ON <br /> 1 . <br /> EH 22 0 L3 (Rev. 03!20/93) : . <br />