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0 SAN JOAQUIN COUNTY 0 <br />NOTIFICATION OF HAZARDOUS WASTE DISCHARGE 0 D <br />HEALTH & SAFETY CODE 25180.7 Lr <br />A. EMERGENCY LEVEL: I II III PHS -EH LOG # <br />(Circle One) v <br />B. SOURCE OF INFORMATION <br />C <br />Name: Phone: (204) S,7z-og00 <br />Company: 5ar�� <br />Address: u.o 5 mesas A klf-* �-A=s4Q 9 rn 3! I <br />Designated Employee Name: Phone: �) <br />Reporting Agency Name: <br />Address: <br />LOCATION AND DATE OF DISCHARGE <br />Location: `gyp 1 C> � A r� �{- �\�•1/ <br />(Best Physical Description) <br />Date of Discharge: <br />Time: 2,,-:5o p22 <br />Date Notified: <br />(City or County) Circle One <br />D. RESPONSIBLE PERSON/BUSINESS <br />Name of Business: <br />Contact Person: Telephone: (aea,) �18Z• �µiL <br />Physical Address: 2 M n A' Q Sync k. nt-4 C -A 45 �pG <br />Mailing Address: P. p. k rnMQ+C r gSRa! — 9io i <br />C7. DESCRIPTION <br />Type of Discharge: d LA" <br />Volume: Ll <br />Chemicals: L cb—�d Ga <br />Circumstances: I c� m+ � �Qc,�—�'�►��- - <br />F. ACTION TAKEN --TTiz �� cz l'i►JE �.\�p� rvuyFc� �f 2514 <br />SITE STATUS <br />�n c%g <br />PH 22 013 (Rev.4/91) <br />