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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARG <br /> HEALTH & SAFETY CODE 25180.7 � <br /> A. EMERGENCY LEVEL: II III PHS-EH LOG # (� <br /> ( ircle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Phone: �) <br /> Company: <br /> Address: <br /> Designated Employee Name: W u1/fPhone: yU,"y 3c ./ <br /> Reporting Agency Name: 5 rG P it S -e7 H <br /> Address: --o� (-% uue(a --r- 31 e--, <br /> C. LOCATION AND DAT OF DISCHARGE <br /> Location: rNr,061AIIM��ti�C�r�i�Y dGtt Lay <br /> (Best <br /> (Best Physical Description) IhCj�k��,ti e ,(City or(5oun Circle One <br /> Date of Discharge: <br /> Date Notified: Time: <br /> D. RESPONSIBLE PERSQN/BUSINESS <br /> Name of Business: <br /> Contact Person: (.irv4li (�--Y,2cc 2d Telephone: 6LOD 44 - 3633 <br /> Physical Address: 375 k) (,Uine-' ixt L;i loo JA)ojVtuf <br /> Mailing Address: v <br /> E. DESCRIPTION <br /> Type of Discharge: U V),IGv kl�'n <br /> Volume: U'v V-V "N^ <br /> Chemicals: h' -t r 6m5 e4�,ul •�. Cl Co r� � <br /> Circumstances: Sail )Nn'ngs a4- 5i le fizRzt-lF� GQ'k1 OPA utnirall An -FMA,-- <br /> �P_h rn�ny' ojea:6- <br /> F. ACTION TAKEN_ A20(4 U;1w+Eh f(bC �SS P$10&(-• sc--G o(�E <br /> S TE STATUS (l2 W (� IUG G�� is VDv��iPCv Wa j,V-vr�(Gb -.G� y(�e <br /> �V\ULfi�r Aa-h�n rl utF,l �(�✓� u_o �t. �l-�t7S Sim - <br /> EH 22 013 (Rev.4/91) VW1�-k -.7 \.2i C}o're, <br />