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AN JOAQUIN COUNTY <br /> NOTIFICF_ OF HAZARDOUS WASTE DISCFE <br /> �ALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL I II III PHS-EH LOG <br /> cle One) <br /> B. SOURCE OF INFORMATION <br /> Name: e d-M Phone: CZZn q93-131-10 <br /> Company: a F <br /> Address: ZCr&22er Q G <br /> Designated Employee Name: 7�2 rn 11164e-& _ Phone: <br /> Reporting Agency Name- <br /> Address: <br /> C. LOCATION �DATE OF pI�HARG� <br /> Location: °� - <br /> {Best Physical Description) CEr County) Circle One <br /> Date of Discharge: i-p" e& <br /> Date Notified: 2! 91 Time: //=D 0 R-^-\ <br /> D. RESPONSIBLE PERSOWBUSINESS <br /> Name of Business: LOra 7 _. <br /> Contact Person: � v�.c% Telephone: 2G`' 94�� --02 <br /> Physical Address: a531 Lr- <br /> ' <br /> Mailing Address: 9 <br /> E. DESCRIPTION k <br /> Type of Discharge: lea <br /> Volume: <br /> Chemicals: o r <br /> Circumstances• <br /> F. ACTION TAKE � <br /> SITE DISPOSITION lnez ,%�~ <br /> dAJ <br /> EH 22 013 (Rev.4/91) <br />