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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 <br /> PHS-EH LOG # / 7 <br /> (Circle One) <br /> B. SOURCE OF INFORMATION Phone: X13 • -3 <br /> Name: tcc�i9cti �' <br /> Company: <br /> Address: Q0.' <br /> Phone: (—J <br /> Designated mployee Name: r �,✓. <br /> Reporting Agency Name: &7-o <br /> �^ <br /> Address: <br /> Sr- <br /> C. LOCATION AND DATE OF DISC GE <br /> Location:�� ��� (City or County) Circle One <br /> (Best Physical Description) <br /> Date of Discharge: + Time: <br /> Date Notified: — L <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: Telephone: �� L z_ �—?0` 2 <br /> Contact Person: z r <br /> Physical Address: Z� <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: <br /> Chemicals: <br /> Circumstances: <br /> K 092 <br /> /N <br /> F. ACTION TAKEN 6 <br /> SITE STATUS All <br /> EH 22 013 (Rev.4/91) <br />