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:ylG.rwcc"y <br /> SAN JAQUIN COUNTY — <br /> NOTIFICATION OF HAAZARDOUS WASTE DISCHARGECopyHEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVELOII III PHS-EH LOG # 7 / <br /> ircle One) <br /> B. SOURCE OF INFORMATION <br /> Name: RO q-v"LI c-,fV-S Phone: <br /> Company: 51Mt <br /> Address: 67 <br /> Designated Employee Name: W LJL4P.r— N AQP Phone: 3 2 v <br /> Reporting Agency Name: . :YD N <br /> Address:_ to g 7 . S—fUc, FYN <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: ��OI S i P ST <br /> (Best Physical Description) (City or County) Circle One <br /> Date of Discharge: <br /> Date Notified: I— I 'f—ol Time: 0 D &7' ,i <br /> D. RESPONSIBLE PERSON/BUSINESS 1 <br /> Name of Business: rrP—4k, CJk JS P L F/ <br /> Contact Person: -_az) " ; Telephone: ( L X11 — ` <br /> Physical Address: !'j i I z.,.. eA �T , S'TQ �t�,vi , 9 �-7.Z C <br /> Mailing Address: :7 n 1 A-�--4,r o J� rt 4,,-. P , <—fo c,/457&2� r..,4 L.2l <br /> E. DESCRIPTION Q <br /> Type of Discharge: U til LO-6 w (J <br /> Volume: U N k v` U '� <br /> Chemicals• �� y�i� ,ti vt� <br /> Circumstances:_s - I L 34 3z D • ee -„� _/ <br /> 1(Zt�ti r J C-- 0 f l STc <br /> F. ACTION TAKEN Ce- e. lv`de/ucyrc; v.,r\ 4 ti j <br /> rtz n r- \ )a.r o rJ I G — 0 al L,L ” <br /> SITE DISPOSITION -- L L <br /> EH 22 013 (Rev.4/91) <br />