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SAN JOAQUIN COUNTY <br /> NOTIF��ATION OF HAZARDOUS WASTE Dlt,,-HARGE <br /> HEALTH & SAFETY CODE 25180.7 - <br /> t' . <br /> 4E?MEtRGENCY <br /> LEVEL:VI II III PHS-EH LOG # <br /> (Lzcle One) <br /> B. SOURCE OF INFORMATION C .3�7- 76 P <br /> Name: Phone• //� <br /> Company: SC-CD /AvTG t�VC 6 <br /> Address: 301-7- <br /> Designated Employee Namea� -G Phone:-: <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE 9F/��E � / LP�u� <br /> Location: <br /> (Best Physical Description) to or County) Circle One <br /> Date of Discharge: <br /> Date Notified: F'4t.0 6 Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: G e E <br /> Contact Person: Telephone: 3 • ZP <br /> Physical Address: <br /> Mailing Address: . Q <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: 11 <br /> Chemicals <br /> Circumstances: <br /> 5 c l <br /> F. ACTION TAKEN <br /> SITE STATUS <br /> EH 22 013 (Rev-4/91) <br />