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r "SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE � <br /> HEALTH & SAFETY CODE 25180.7 r, _ <br /> A. EMERGENCY LEVEL: III III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Phone• 4(!� )_7Z-T–S3/-S. <br /> Company: <br /> Address:_ A✓x <br /> Designated Employee Name: Phone: C <br /> Reporting Agency Name: _� ! <br /> Address: <br /> C. LOCATION ANDD TE OF DISCHARGE <br /> Location•. / .5�4� <br /> (Best Physical Description) ': (City or oun Circle One <br /> Date of Discharge: o�v <br /> Date Notified: Time: ov <br /> D. RESPONSIBLE PERSON/BUSINESS x . <br /> Name of Business: <br /> Contact Person: Telephone: L <br /> Physical Address: Z- � <br /> Mailing Address: hoc. To <br /> 44— Zell <br /> E. DESCRIPTION F, <br /> Type of Discharge: <br /> Volume: LSA ` <br /> Chemicals: <br /> Circumstances: .Q "moi Sd G y v.Cr .j fj4ovi¢L <br /> er <br /> F. ACTION TAKEN •- �a•Qid ��1�( , <br /> 2PZ6 14A <br /> AL <br /> SITE DISPOSITEON '' G DDS F `�' �� c�J•".�.�•il�trtT�� <br /> . EH 22 013 (Rev.4/91) L. ; <br />