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`..� SAN JOAQUIN COUNTY ...' <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> copy <br /> A. EMERGENCY LEVEL -0I III PHS-EH LOG <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: .b r a d Phone: PZ�T) S 33- <br /> Company: r2�E6 <br /> � <br /> Address: (�-1 e�- T ✓ <br /> Designated Employee Name: Phone: �) <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 14 0 S 01a--t r 6+r e e <br /> (Best Physical Description) Ci or County) Circle One <br /> Date of Discharge: ^- <br /> Date Notified: 71 1 Time: ! 0 i) jP r '` <br /> D. RESPONSIBLE PERSON/BUSrNE S <br /> Name of Business- �+ 0 �sC�to c-� <br /> Contact Person: e r-- Telephone: e-d <br /> Physical Address: a 9 ^ <br /> Mailing Address: a Y, Es 5 3 2� <br /> E. DESCRIPTION <br /> Type of Discharge: �-- <br /> Volume: t In k^ ►�- <br /> Chemicals: MT8 <br /> Circumstances: a l S ae re-su-1-4:So u <br /> r <br /> F. ACTION TAKEN Lj n� � �� <br /> SITE STATUS <br /> L.a. A .� <br /> EH 22 013 (Rev-4/91) <br />