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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCIt III • <br /> . s <br /> B. <br /> • • •R- OF INFORMATION <br /> Name: Phone: <br /> Company: 1'g &jTL ,r <br /> Address: i i , „ t <br /> LOCATIONDesignated Employee Nam: -3 <br /> C. r DATE OP,DISCHARGE <br /> ink►..dl. �. .L'.II J <br /> Date r , • 144 <br /> DWWIAK <br /> Date • • a • ' Iasr1► <br /> D. RESPONSI= PERSOWBUSINES <br /> Name of Bus1ness:('4--m-j-rt' -tAt&JL634 <br /> contact Pers Tat2hom. 97- r? <br /> Physical Address: <br /> j:x jr <br /> Mailing Address: <br /> E. DESCRIPTIO <br /> Type of r k ?., <br /> • ...� <br /> Chemicals: a A .a <br /> F. • • n11 • A&jaac <br /> .s <br /> 24 <br /> r g 14 <br /> EH 22 013 • <br />