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SAN JOAQUIN COUNTY . <br /> I` NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> i <br /> A. EMERGENCY LEVEL: I II 1II PHS-EH LOG # 7-5 <br /> cle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Phone: C <br /> Company: <br /> Address: <br /> Designated Employee Name: am Phone: (f,01) y68-4335 <br /> Reporting Agency Name: Envirmavaii- #4d,* <br /> Address: G SZov <br /> C. LOCATION D DATE OF DISC GE <br /> Location: K0 0 Q j� S Qt P / <br /> (Best Aysical Description) City' r County) Circle One <br /> Date of Discharge: j <br /> Date Notified: _ 6--20 -q Time: 7_ . IM _ <br /> D. RESPONSIBLE PERS�N/ USI ES <br /> Name of Business: i <br /> Contact Person: J--WA-61 FVLIZu n Telephone: (Y'OD 'B <br /> Physical Address: 2 2 DZ <br /> Mailing Address: zt22a e, <br /> E. DESCRIPTION <br /> Type of Discharge: V <br /> Volume: <br /> Chemicals: <br /> Circumstances: ria. o <br /> F. ACTION TARN <br /> SITEST TUS <br /> 62 <br /> EH 22 013 (Rev.4/91) <br />