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SAN JOAQULN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCH.A-RGf ILE C <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEq1-rcile <br /> I III PHS-EH LOG <br /> one) <br /> B. SOURCE OF INFORMATION <br /> Name: s, ` Phone: ('lam --_ 3(A <br /> Company: L'(, V\A _ <br /> Address: <br /> Designated Employe- Phone.Name: l�l.+c 'r ted�-+ - — �-(� <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AN,-D DATE OF DISCH.�RGE <br /> '7 <br /> Location: i r County) Circle one <br /> (Best Physical Description) <br /> Date of Discharse: v �'_ Time: <br /> Date Notified: r I - 0 0 <br /> D. RESPONSIBLE PERS(�ONBUSINE�S�S <br /> Name of Business: I,� y� L <br /> IS- <br /> Contact Person: , t cI <br /> Physical address crO r <br /> Mailing address: <br /> E. DESCRIPTION <br /> T-,-pe of Discharge: <br /> Volume: yk <br /> Chemicals: <br /> Circumstances: <br /> F. ACTION TAKEN <br /> SITE DISPOSITION <br /> 2 <br /> EH 22 013 (Rev- 081'20/98) <br />