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SAN JOAQUIN COUNTY <br />NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br />HEALTH & SAFETY CODE 2SI80-7 <br />A. EMERGENCY LIEVEL:0 ri III PHS -EH LOG fir' <br />(Circle One) <br />B. SOURCE OF INFORMATION <br />2'r <br />Name:Phone: <br />Type of Discharge: <br />Q0Z <br />Co=any-. <br />Vol=e: <br />Address: <br />Designated Employee Name: Lg--r; /3 r i Q <br />< Phone: <br />Reporting Agency Name: <br />j - <br />Z,,,- <br />.c' <br />Address: <br />C. LOCATION AND DATE OF DISCHARGE <br />Location: 22',/.�A Z---, <br />&I <br />- / �-57& <br />(Best Physical Description) <br />;(^ A I 4,t7 <br />(City OCC—ounr`yCircle One <br />Date of Discharge- <br />Date Notified: <br />Time: <br />3 <br />D. RESPONSIBLE PEIRSON/BUSINESS <br />Name of Business: <br />Conrac,L*Penom—�a,��-(-,-"�s,g-.,, <br />Telephone: <br />Physical Address: Te. <br />Mailin- Address: <br />0 /1;` <br />/ <br />S -t r 14 <br />E. DESCRIPTION <br />Type of Discharge: <br />Vol=e: <br />aliernicals: <br />/m, <br />4 - <br />Circumstances: <br />Z,,,- <br />�-13 <br />F ACTION TAKEN <br />;(^ A I 4,t7 <br />EH 22 013 (Rev -4/91) <br />