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0 0 <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: a III PHS-EH LOG # 1 <br /> (Ode One) <br /> B. SOURCE OF INFORMATION <br /> Name: Phone: s 6 ;?61 I fO <br /> Company: /6X-, � u <br /> Address: o <br /> Designated Employee Name: 1(5Phone: <br /> Reporting Agency Name: P 1 iii' <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: O-�;,S D S. -r f✓� / <br /> (Best Physical D criptionr ounty) Circle One <br /> Date of Discharge: 119, <br /> Date Notified: 3 Time: <br /> D. RESPONSIBLE PERSON/BUSIN S <br /> Name of Business: /T <br /> Contact Person: Telephone: (Slh) � <br /> Physical Address: '" 42 <br /> Mailing Address: �— e6 h <br /> E. DESCRIPTION <br /> Type of Discharge• <br /> Volume: <br /> Chemicals: <br /> Circumstances: <br /> F. ACTION TAKEN <br /> SITE STATUS <br /> EH 22 013 (Rev-4/91) <br />