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�r SAN JOAQUIN COUNTY �../ <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG # `7 C�D <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Ur-I nem Wcyl I Phone: Za X15 Z-10353 <br /> Company: OcuAovx i c <br /> Address: �, w Psd- <br /> Designated Employee Name: Phone: (_) <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 434�) 5-- <br /> (Best Physical Description) (City o County Circle One <br /> Date of Discharge: ynl4low ✓1 <br /> Date Notified: 1 3 1_� Time: D <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: Lw^c-+ioj <br /> Contact Person: Telephone: PL)fj 4 q5--!(-3 <br /> Physical Address: .434 3 <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: (11 ;-�- <br /> Volume: �,v►r1 . <br /> Chemicals: tr (ev,� CIYoC�✓f� Y�S �- o��v So(c.�en <br /> Circumstances: v t oYc4j ►^erYtoJ <br /> F. ACTION TAKEN () r o J,� - � ✓' 1t� J� �ftj Die <br /> Com-V12 r�� <br /> SITE DISPOSITION t ST C D S{--o M Lxl<ZtL M WLLk C Cc <br /> LU Pra Y-e-P p r`f CL-,- Gk CLdCLOI ,gyp <br /> ✓tic_ 5 i Cc. so- . d (yt v25 t� <br /> l C cJc e &?jtQ o K �Cz <br /> EH 22 013 (Rev.4/91) <br />