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• SAN JOAQUL T COUNTY • (• <br /> -NOTIFICATION OF HAZARDOUS WASTE DISCMt Cnps# <br /> HEALTH & SAFETY CODE 25130.7 <br /> A. EMERGENCY LEVEL: II III PHS-EH LOG T ` " L/`/'0 <br /> (Circle one) <br /> B. SOURCE OF INFORMATION <br /> Name: J e:-4 it <br /> Phone: ( ) <br /> Company: L v'c rN vnv: <br /> Address: 5 <br /> Designated Emplove--Name: Phone: <br /> Reporting agency Name: <br /> Address: <br /> C. LOCATION ASND DATE' `OF DISCHARGE <br /> Location: 339-9- W e-5+ L�✓�e ` �- - -o„`�- <br /> (Best Phvsicai Description) (City or ounty Circle one <br /> Date of Discharge: Qv-,k—, V\b U") <br /> Date Notified: � '3 Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: T Q-' '� <br /> Contact Person: c ! a_-i'� Phone: 2� -3-10 7 . <br /> Phvsical Address: . o Dj c- <br /> Mailing address: c C \ S / <br /> E. DESCRIPTION <br /> Type of Discharge: L�� <br /> Volume: t,\, <br /> Chemicals: o ( i r" e e 5<'- <br /> Circumstances: ) j 1X r-1--V-r 5 a I I C1 rt A <br /> F.- ACTION TAKEN er4rgv --4-vpn K5 � c� <br /> SITE DISPOSITION ► <br /> n <br /> EH 22 0 L 3 (Rev. 08/20/93) <br />