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SAN JOAQUIN COUNTY .. <br /> ` NOTIFICATION OF HAZARDOUS WASTE DISCHARGE' <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG #_,_ <br /> (Circle One) <br /> B. -SOURCE OF INFQRMATION �-- - •- <br /> Name, Phone: <br /> Compare <br /> :, - <br /> .Address:- > �...r <br /> Designated Employee Name: Phone: �) <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DIS GE <br /> Location: i Au. .h.��^I�,� <br /> (test Physical �}esanption) (City or,�ty�Circle One <br /> Date of Discharge: <br /> L I.C1 t <br /> Date Notified: 17-1 d le,r'_ Time: <br /> D: RESPONSIBLE PERSON/BUSINESS r ." <br /> Name of Business. N i<0/1 i <br /> Contact Person: L_7_21; ,r. ZRJ _ Telephone: kt) <br /> Physical Address: <br /> Mailing Address: r36, U z � �;.! 7 r 81 C <br /> E. DESCRIPTION _ <br /> Type of Discharge: U . <br /> Volume: LAA,�� _ <br /> Chemicals: - *�. .LLc <br /> Cixcumstanc S: �.`,fir., ;,(a:.,`�..., ^�.� ' .0 � �-• ✓t s � J1.cn A,7y-r�nA ' fiti <br /> F. ACTION TAKEN 01 C_4v-� <br /> 1 <br /> SITE DISPOSITION , '4P__ <br /> i <br /> EH 22 013 (Rev.4/91) <br />