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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 />(Circle One) <br />B. SOURCE OF INFORMATION <br />Name: Aya Yl 50rAde 624?2 .4'1011 <br />Company: GoEP094- 'iQA- <br />Address: 20600 4ou,Y 0A21E- , / 4,4, / <br />C. <br />RE <br />E. <br />F. <br />Designated Employee Name: <br />Reporting Agency Name: <br />LOCATION AND DATE OF DISCHARGE <br />Location: 20400 1/0"0' 0,820? <br />(Best PhysicalDe cri tion) <br />Date of Discharge: 6 z <br />Date Notified zl <br />RESPONSIBLE PERSON/BUSINESS <br />Name of Business: <br />Contact Person: E �� <br />Physical Address: 7v6r0o i� �6Lf �% <br />Mailing Address: P o- i3ox 60 <br />DESCRIPTION <br />Type of Discharge: <br />Volume: 7K- IQ�, <br />Chemicals: -;er <br />PHS -EH LOG # 273- 02 ft— <br />Designated <br />- <br />Time: ^ -q 549-t Yn <br />�:,:q g3�5-3Zio <br />Phone: (__) <br />i(�r County) Circle One <br />Telephone: <br />EH 22 013 (Rev.4/91) <br />