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orf <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 COPY <br /> A. EMERGENCY LEVELG I1 III PHS-EH LOG <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Phone: <br /> Name: <br /> Company: <br /> Address: <br /> Designated Employee Name: rA -e r Phone: (�`�) - `�� <br /> Reporting Agency Name: <br /> Address: 4q ti t <br /> C. LOCATION AND DATE OF DISCHAR <br /> Location: Le�? U2 5 / <br /> (Best Physical Oekription) �nj�r County) Circle One <br /> Date of Discharge: �- <br /> Date Notified: Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: Fr- -s <br /> Contact Person: Fra,IC_. &ult �-�t'— Telephone: <br /> Physical Address: <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: <br /> Chemicals: <br /> Circumstances: UY m e a✓L c <br /> —� c r� Gfi�'L fl r'© h't <br /> F. ACTION TAKEN <br /> r <br /> SITE STATUS Ld` G` L <br /> EH 22 013 (Rev.4/91) • <br />