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0 <br /> SAN JOAQUIN COUNTY <br /> NO=1CATI0N OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> * � <br /> A. EMERGENCY LEVELOe <br /> III PHS-EH LOG x <br /> One) <br /> B. SOURCE OF INFORMA'TTON <br /> Name: /C / Phone: <br /> Company: <br /> Address: D• 6 a Of 7kS'd 3 -®g0 <br /> Designated Employee Name: Phone: ( ) 3 S" <br /> P orr.Lncr Agency Name: aG C'o G ' Opti <br /> Address: apf <br /> C. LOCATION AND DATE OF DISCl-filA G"4 C� <br /> Location: 4;�oU7-7 <br /> (Best Physical Descipt icn) (City orCircle One <br /> Date of Discharge: <br /> Date Nodded: 3 2 Tune: /'064222n_ <br /> 0. RESPONSIBLE PERSON/ 'Su�iESS <br /> Name of Business: �dc�Lcf <br /> Contact P°.*son: / Te?enhone: Sig �yz �6g.r" <br /> Physical Address: <br /> M - Address: 6 do a , <br /> v. DESCRIPTION <br /> Tyne of Discharge. <br /> Volume: <br /> Cne_micals: <br /> C mni srances: /r".P?ot/ <br /> ACTION TAKEr'V <br /> SITE DISPOSt'i"IQN G(e ic% / <br /> EH 22 013 (Rev.4/91) <br />