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1 <br /> Q <br /> SAN JOA UIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTC-7 <br /> G <br /> HEALTH & SAFETY CODE 251 <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG <br /> ( cle One) <br /> B. SOURCE OF INFORMATION Phone: �U �L- <br /> m <br /> Nae: / N <br /> Company. ,t''v�7! A/110 L S , <br /> Address: <br /> Designated Employee N Phone: L� <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE / <br /> Location: '4*06 <br /> (Best Physical Description) 5LOr <br /> County) Circle One <br /> Date of Discharge: <br /> Date Notified: Time: <br /> D. RESPONSIBLE PERSON USINESS <br /> Name of Business: <br /> Contact Person: Telephone: C-S/(a E <br /> Physical Address: <br /> Mailing Address: 94� 3 <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: <br /> Chemicals: . 6• T. <br /> Circumstances: f <br /> /411 <br /> r <br /> F. ACTION TAKEN •/P- <br /> s•'Ch <br /> SITE STATUS f <br /> Gc.6• 7,-1 <br /> 2 <br /> EH 22 013 (Rev-4/91) <br />