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1 , SAN JOAQUIN COUNTY . <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: (�rti I III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Phone: (2 1)57z- C?oc2 <br /> Company: <br /> Address <br /> Designated Employee Name: Phone: t�) <br /> Reporting Agency Name: <br /> Address: '3nri E. wEBE� v4v� TA).� Fi�.2 , Srd�a—rte, rte{ ��z�Z <br /> C. LOCATION AND DATE OF DISChIARRG� <br /> Location: 53c, Tzf.�w <br /> (Best Physical Destiop) County) Circle One <br /> Date of Discharge: wAl <br /> Date Notified: , /-,- Av- Time: 1c, <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: <br /> Contact Person: Telephone: L <br /> Physical Address: 33D <br /> Mailing Address: 330rrrar+i. I All <br /> E. DESCRIPTION 9 <br /> Type of Discharge: "'Al <br /> Volume: moi. k/ <br /> Chemicals: <br /> Cir tances: f. �- <br /> l 'T-/�h <br /> F. ACTION TAKENy 57— -S <br /> SITE DISPOSITION <br /> EH 22 013 (Rev.4/91) <br />