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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> (( n <br /> HEALTH & SAFETY CODE 25180.7 "`` L�-/� <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG # %15 -D b <br /> (Pcle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Zer-nie) Phone: ( .(3) 334211Z <br /> Company: <br /> Address: X17 r (^ <br /> Designated Employee Namf Phone: L� <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DIyaCHARGE <br /> Location: 4cOZ KI C ju4r1 I M' C%1 / <br /> (Best Physical r�es ption) ty r County) Circle One <br /> Date of Discharge: 4I- :Er9s <br /> Date Notified: Time:_ '9,+s nM <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: <br /> Contact Person: R=- ^� Telephone: <br /> Physical Address: cs Q Z XI. 01 U Qd i CAI <br /> Mailing Address: 5,1^ <br /> E. DESCRIPTION <br /> Type of Discharge: l)nLli, 11,c,ri7rrf re (en< u -Ire, is Rn'tz` Air+Qmm�� <br /> volume: 10-'' <br /> Chemicals: A <br /> Circumstances: S6melnmty ant -Le tAdS r-PLea SeA <br /> n V42�,1 k - - u;-Ao✓ In " --- <br /> F. ACTION TAKEN Absurba-af- ami c, 14111 rl '6." nlr>Scsrb�¢_ <br /> mf, Prr� ( �(11e (�hSnlhcn I d /`N -d rintac/ �I �,+ r in , nfn turf I r) /a <br /> SITE DISPOSITION Nten�T <br /> EH 22 013 (Rev.4/91) <br />