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L.. SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: (D 11 III C01P'vS-EHL0G # I ! f <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: \l Z 0 n K c` Phone: ( 65'Fo-S4c,�4 <br /> Company: C'c, <br /> Address: C3. Ari-csac� 90�OZ-��C3R <br /> Designated Employee Name: �'-/ez—zLN�ok c- Phone: 8-0335 <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE Sita Com\ <br /> Location: 205 K. <br /> (Best Physical Description) Ci r County) Circle One <br /> Date of Discharge: 8 -Z(n - rrS <br /> Date Notified: q - I -qs- Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: -4� 4'+q3 <br /> Contact Person: Telephone: eg;ED 44 8- 0838 <br /> Physical Address: ZQT A/ <br /> Mailing Address: <br /> E. DESCRIPTION � <br /> Type of Discharge: Vnh( CJ c F r ( rv�, �nrrst r <br /> Volume: cellc", <br /> Chemicals: <br /> Circumstances: ai-Q o--� ckiax, -%cr <br /> F. ACTION TAKEN rnosOc-bcv-%-i' n,C- <br /> Cu-)L <br /> ��I <br /> CMZ Cci� t t c�c rc�l 4<m �r �3�m o (an; n� 4--kr- <br /> SITE <br /> krSITE STATUS �+ZcLktt3 mndc 10 d�ociasc� r�� Clcrty'Jc' <br /> EH 22 013 (Rev-4/91) <br />