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SAN JOAQUIN COUNTY <br />NOTIFICATION OF FIAZARDOUS WASTE DISCHARGE <br />HEALTH & SAFETY CODE 25180.7 <br />A. EMERGENCY LEVEL.0II III <br />(Circle One) <br />B. SOURCE OF INFO ON'J <br />Name: YJ <br />Company: <br />Address: <br />Designated Employee Name:_ <br />C. LOCATION AND DATE <br />Date of Discharge: _ <br />Date Notified: <br />D. RESPONSIBLE PERS( <br />Name of Business:_ <br />Contact Person: <br />Physical Address: _ <br />Mailing Address: <br />E. DESCRIPTION <br />Type of Discharge t <br />Volume: <br />Chemicals: <br />F <br />DHS-EH LOG <br />Phone: aC <br />r County) Circle One <br />Telephone: (a4l--o 71/-'-- <br />J. <br />EH 22 013 (Rely 4/91) <br />