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. SAN JOAQUIN COUNTY • <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I PHS-EH LOG <br /> (Circle ne) <br /> B. SOURCEF INFORMATION <br /> Name: �B Phone: 7/ 63a -tea/ <br /> Company: - <br /> Address: 000 ;411 <br /> Designated Employee Nam6-' Phone: (__3 <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: <br /> (Best Physical Des tion) City r County) Circle One <br /> Date of Discharge: <br /> Date Notified: 6'-1.--9-3 Time:���rn <br /> D. RESPONSIBLE PERSON/BUSINESS ���� <br /> Name of Business: 6(LCLc� 70 �c �rScuiL � o <br /> Contact Person: Telephone: <br /> Physical Address: /00 <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: �c rix a r 9�c® ui-off <br /> Volume: <br /> Chemicals: Tf'�/ L /L <br /> Circumstances: <br /> F. ACTION TAKEN <br /> SITE DISPOSITION — � <br /> C d <br /> EH 22 013 (Rev.4/91) <br />