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SAN JOAQUIN COUNTY <br />NO'T'IFICATION OF HAZARDOUS WASTE DISCHARGE <br />HEALTH & SAFETY CODE 25180.7 <br />A. ETMERGE1NCY LEVE iL• I DI( e One) <br />B. SOURCE OF INFORMATION <br />Name: <br />Company: :-rrl <br />Address: 2-4-LS-- <br />Designated <br />-4Ls-Designated Employee Name: S7 - <br />Reporting Agency Name: 6.71-11r <br />C. <br />w <br />E. <br />LOCATIONA ,N� DATE OF ISCHA <br />Location: XfI /- <br />(Best Physical Description: <br />Date of Discharge: <br />Date Notified: <br />RESPONSIBLE PERSON/BUSINESS <br />Name of Business: <br />Contact Person: ,/ W/ll—le, <br />Physical Address: <br />Mailing Address: ,lZgl AbIA4 <br />n�cr*,� rorr-rn�r <br />EWA <br />PHS -EH LOG � V 13 <br />Phone: (Loj7 yb%-&3z1`1- <br />/•�'� �Lci <br />Y- County) Circle One <br />F. ACTION T. <br />EH 22 013 (Rev.4/9I) <br />