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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISGE i <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II IIIC(DPNVHS-EH LOG # /�- 074 <br /> ( ' cle One) <br /> B. SOURCE OF INFORMATIQN <br /> Name: 6e-h mcg eq c� Phone: � '(0-�1 SOU <br /> Company: "O . <br /> Address: 1(10 , ' ErS Lti <br /> Designated Employee Name: Phone: (_) <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF I?ISCHAjGE / C� <br /> Location: 2 35 A A VL,i ) <br /> (Best Physical Description) i or County) Circle One <br /> Date of Discharge: <br /> Date Notified: _j-S-Ll Z Time: may.^ <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: i,?0f It <br /> Contact Person: m c Tele hone: (- <br /> Physical Address: 1 Imo, ' G•4C 'c°�1 & <br /> Mailing Address: <br /> E. DESCRIPTION "Yh <br /> Type of Discharge: <br /> Volume: UM <br /> ti��� <br /> Chemicals: --#� FT 41 t <br /> _ <br /> Circumstances: <br /> F. ACTION TAKEN UP r6& -414r� 1 <br /> S(TE DISPOSITION i / 'z /'V° <br /> Gt j 1 ill d�-t l 'fz' cc i�C i <br /> EH 22 013 (Rev-4/91) <br />