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SAN JOAQUIN COUNTY`"W <br /> YOTMCATION OF HAZARDOUS WASTE DISCHME UPI HEALTH & SAFETY CODE 25180.7 <br /> A. <br /> EMERGENCY LEVE . II III PHS-EH LOG Y 9 <br /> Circle one) <br /> B. SOURCE OF INFORMATION <br /> Name: <br /> Phone: ��30 - b�0 <br /> Company: <br /> Address: <br /> Designated Employee Name: Phone: <br /> Reporting Agency dame: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: '3 Ow,, ux.", 9-6- / dL� <br /> tBest Physical Description) (City or Cour Circle one <br /> Date of Discharge: lt)AL, <br /> Date Notified: Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: <br /> Contact Person:- Phone - L o a <br /> Phvsical address: <br /> Mailing address: 60 3 8) �Zo Ste - 6 r <br /> E. DESCRIPTION <br /> Type of Discharge:_' �'`"u�-F <br /> Volume: fa/ , <br /> Chemicals: u <br /> Circumstances: ru r <br /> F. ACTION TAKEN U�! �'^� 3 3 9 9 Ll A-lZ �rG <br /> L <br /> 6 ® � <br /> SITE DISPOSITIONS <br /> anti C <br /> EH j2 013 (Rev. 0910/93) <br />