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Q <br /> SAN JOA UIN COUNTY <br /> NOTIFICATION'OF HAZARDOUS WASTE DISCHARGE . <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II .III <br /> PHS-EH LOG # <br /> ( arcle One); . <br /> B. SOURCE OF INFORMATION �� Z- f00m <br /> Nae: p c hr,6% R (15 u Phone: C—) <br /> Company: G L a. <br /> Address:_ 1031 Sws i�-r.:P�+�•►-e� d�8�o Cf <br /> Designated Employee Name:.. Phone: <br /> Repo <br /> Addrrting Agency Name: <br /> ess• ` ' <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location:_ <br /> (Best Physical Deption) ( i r County) Circle One <br /> Date''of Discharge: <br /> Date Notified: (o -Z -tet ..:Tune: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business:` <br /> Contact Person: e Telephone:`(_� <br /> Physical Address: U ° 'r 5 GCGtb*� �1 S"La3 <br /> Mailing Address: <br /> . I <br /> E. DESCRIPTION <br /> Type of Discharge: &k_ <br /> volume: n <br /> Chemicals: R <br /> Circumstances: <br /> F. ACTION TAKEN <br /> - z - <br /> LOf 47la// <br /> SITE STATUS <br /> EH 22 013 (Rev.4/91) <br />