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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVELpircle <br /> II III PHS-EH LOG One) <br /> B. SOURCE OF INFO ATION <br /> Name: Phone: <br /> Company: C <br /> Address: HD2nd � � Q �►Q�-e� �-4- q43 <br /> Designated Employee Name: Phone: <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE L M - <br /> (! RGE <br /> Locarion: ��R , naQ�l / <br /> (Best Physical Description) (City or oun Circle One <br /> Date of Discharge: unmw n <br /> Date Notified: - Time: 3'. QAr1 <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: --i g i LdA ttn _ <br /> Contact Person: Telephone: 7). _ -_ CZI <br /> Physical Address: C <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharger- �yYL V S <br /> Volume: U-,.r)4-/� <br /> Chemicals: <br /> Circumstances: tjS <br /> F. ACTION TAKEN yAhm Yma -&,12 K ��,!/fZ d1/� 5640 <br /> SITE STATUS ZVI lbe <br /> CkoGr& amdciu <br /> ` E of G <br /> EH 22 013 (Rev.4/91) <br />