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�- JOAQU�IN COUNTY <br /> ENvIRC(0 [py <br /> ONMENTAL HEALTH DEPARTMENT2708 <br /> r td Floor, Stockton, <br /> N ` 304 East Weber Avenue, 3 oa um-ca.us/ehd <br /> x <br /> (209)465-3420•Fa . (249)464-0139 • yVeb: vnv�v.co.san-j Q <br /> HAZARDOUS `PASTE DISCHARGE <br /> C9LlFo�a` <br /> NOTIFICATION OF <br /> Califoz-nia Health & Safety Code, Sect <br /> ioati 25180-7 <br /> O! <br /> EHD LOG #. <br /> A. EMERGENCY LEVE (Cire1 one) <br /> SOURCE OF INFOR�tiIATION c '333— <br /> b 7S <br /> B. 'Phone: (I <br /> Qit,�aJ� N � lLt1SvN <br /> Name: MSL S¢� vt <br /> Company: 0�7 £ 11 5 S 2v City: <br /> Zip Code: ys37� <br /> Address: <br /> Designated Employee Name: <br /> Zip Code: <br /> Reporting Agency Name: City: <br /> ,Address: <br /> . ION AND DATE OF DISCHARGE Cit or Count,,,- <br /> CLOCATren�� C 11% 01102b. (Circle oi, <br /> Location: E <br /> (Best Physical Description} <br /> q' <br /> Y (A%S)P N` <br /> r.r� Date Notified. 2 <br /> U Time: <br /> Date of Discharge: <br /> D. RESPONSIBLE PERSONIBUSI SCO. � <br /> ACS 7�rU' Phone: (Z� 7 L <br /> Name of Business: Js}� �Se� <br /> Zip Code: 7 S_ <br /> Contact Person: �. FAQ ��� City: <br /> Physical Address: City: Zip Code: <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: S� l <br /> Volume: �►a 1L,.n►^,+-y �.a�.a l.. Fn 1 <br /> Chemicals: 6 abo l <br /> Circumstances: <br /> F. ACTION TAKEN: <br /> UV- r W +N VN d 0 <br /> SITE DISPOSITION: <br /> Notification of Haz D{schar€ <br />