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SAN JOAQUIN COUNTY `.• <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:0L I III PHS-EH LOG #_ <br /> (Circle One) <br /> B. SOURCE OF INFORMATION s�o <br /> Name: Z�Ic2y�r �� Y�r/a n/ Phone: ) 63 31d1 <br /> Company: <br /> Address:fYG OD4 112>c-T- 4 fS 2- <br /> Designated <br /> Designated Employee Name: Phone: �) <br /> Reporting Agency Name: <br /> Address: 4- <br /> e <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: / 7 f� S `?' z--�oAjAL� <br /> (Best Physical D criptio ) Ci County) Circle One <br /> Date of Discharge: 6 / -7 72 <br /> Date Notified: 9 Time: /0 :or.., -F!2- <br /> D. RESPONSIBLE PERSON USINESS <br /> Name of Business: <br /> Contact Person: e-64" Telephone: (L o), Z- <br /> Physical Address: 3 7� AJ fi 70 4: !W �c.4 8 <br /> Mailing Address: <br /> DESCRIPTION <br /> Type of Discharge: <br /> Volume: 2 <br /> Chemicals: EY o A .9� 220 <br /> Circumstances: f�-r G Y ��/�•�-eve v7'"low �.a�s <br /> .ecoC�JS� <br /> F. ACTION TAKEN <br /> A E F/J o. r5 c a e U <br /> G _ -AGG�4 <br /> v cow 0 2 ate- ;'Z> <br /> S o�SON Z°E GG�yO <br /> EH 22 013 (Rev.4/91) <br />