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USAN;JOAQUIN COUNTY <br />�. NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:Gl II III PHS-EH LOG # 9..2 - I3� <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: < ,v \N s v "J Phone: <br /> Company: <br /> Address: S:2:2 ,5-- � <br /> Designated Employee Name: W Phone:'C76Y V/1 <br /> Reporting.Agency Name:�!5A V �r4�R�. .ri ��� 5-sz11%1'-- HEAL774 IIC=5-011- <br /> Address:_ <br /> C. LOCATION AND DATE OF DCSqHARGE C <br /> Location: t i ' <br /> (Best Physical Description) (City or C ty) Circle One <br /> Date of Discharge: <br /> Date Notified: „ �f—Z - 7 Time: J," ,7 0 <br /> D. RESPONSIBLE PERSON/BUSINESS rr <br /> Name of Business: o /r J w7ZUv+ ce v,.� <br /> Contact Person: , �r�M1 EEffht_kr36( 5 __Telephone: ` L yvSZ <br /> Physical Address: <br /> Mailing Address: <br /> � - 9J '7- <br /> E. DESCRIPTION <br /> Type of Discharge: f� <br /> Volume: v • .Q <br /> Chemicals: P <br /> Circumstances: C� i^2�r•,, ✓¢_r(- ` L 4 <br /> F. ACTION TAKEN Cc ti +e 5,e. K` <br /> r- <br /> ro e P- r <br /> SITE DISPOSITION 04,. = + mA , <br /> 1A I <br /> Ka'd �. <br /> !ArM,y A- DN StZJtAlgad 16 <br /> EH 22 013 (Rev.4/9I) <br />