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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE CO�� <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG # 7 S — �D <br /> (Eifcle One) <br /> B. SOURCE OF INFORMATION <br /> Name: &4 Z�o/�. Phone: C__,) <br /> Company: A-?,o <br /> Address: ?�Zai o3 <br /> Designated Employee Name: 1 Phone: bI <br /> Reporting Agency Name:—`�- CT, ro' <br /> Address:_ - ,J e ba A� --3 -S,4 cA..� , c,+ s.\z-v Z. . <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 7-o,,7 c% (-O, _lz.- S� / <br /> (Best Physical Description) Cary or County) Circle One <br /> Date of Discharge: �,/) - z sl S <br /> Date Notified: _ /0- -9.r Time: 3-,2.o �r f <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: Arre)_T9-3 <br /> Contact Person: _ �,,, /#."r Telephone: .3 <br /> Physical Address: z -7 A-6L <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: -7&a Siad/ . <br /> Volume: <br /> Chemicals: / <br /> Circumstances:__ <br /> F. ACTION TAKEN <br /> SITE DISPOSITION p,,r rtr_Zw r,,f5i11 P2Ed k1d lac u r lu�,aP <br /> EH 22 013 (Rev.4/91) <br />