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Amw <br /> SAN JOA Q N COUNTY <br /> E,1--,M0NMENTAL HEALTH DEPAR NT k `' <br /> �...,__ <br /> 304 Eubt Weber Avenue, 3'a Floor, Stockton, CA 93102 2708 <br /> (209)468-3420-Fax:(209)464-0138 - Web:Nvww.co.san-joaqunica:us/eh y <br /> NOTMCATION OF HAZARDOUS WASTE DISCHo E� <br /> California Health & Safety Code, Section 25.180.7 <br /> e� <br /> EHD LOG 0 7 <br /> A. EMERGENCY LEVEL: I II III <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: 01u( C4D D rG Phone:.(Ojl) 95T 51 -7 <br /> Company: S S fM RAT- <br /> Address: J 1 HD WLA-V►1) RW City: I Zip Code: <br /> Designated Employee Name:_ M U N(APPA A*04A _ <br /> Reporting Agency Name: T! j-1VJX 3N mgw ' 3D <br /> Address: (vo b t N S City: _ r!!T- V-p1J _Zip Code: Z <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 1.67M t-ffl&jGA7J0 4P-6AP L.9}-9-melU- I rCitv)r County <br /> (Best Physical Description) (Circle One) <br /> Date of Discharge:_ 1 C� /0-1 Date Notified: I� Time: '1 • 3D P.M. <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: - -Ti,�Wl E W r ------ -— <br /> Contact Person: W LL_ Ql�i7Men /J Phone: (Zd7 fSSK-zr-1 I-- <br /> Physical Address: I G'7-n 144 Wt4Wn Qj City: Zip Code: <br /> Mailing Address: City: Zip Code: 5 <br /> E. DESCRIPTION <br /> Type of Discharge:_ Ayy7 M6 AI I t4wl H-vfC>47r'll.0F Li <br /> Volume: 7 A-L <br /> Chemicals: II M W)A A!I•IAS ('t"agog fie <br /> Circumstances: 12MItG __ L rj &n aFtgift8 Q 6 _.G}MaAf o <br /> F. ACTION TAKEN: T/YNIiG -lz A�lz ihJD IVA" <br /> SITE DISPOSITION: L^f TF puGy` <br /> AT IT <br /> EHD 22-02.003 Notification of Har Discharge <br /> I0/2/2003 <br />