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r <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVELILII III CO PWPHS-EH LOG # d V,- <br /> (Ole One) <br /> B. SOURCE OF INFORMATION <br /> Name: Lab Yepc,r-h on Sotl 5--9t-Q Phone: aoq 951 -o3S3 <br /> Company: Cavcrtte. / westtrt <br /> Address: c 3 west (PAvct i Lo-r c- Stec tkta� c 4 <br /> Designated Employee Name: Phone: �) <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 1 -50 Channel <br /> (Best Physical Description) City or County) Circle One <br /> Date of Discharge: LtkK4 tcw( t <br /> Date Notified: 3. - Q2 Time: 2 '•3c P <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: AvA+uftrlt brttha-,-S — C'•t - t>or- Ict5zC1 <br /> Contact Person: ZS t viv`, Ncwve Kt5 P650ctcPVI Telephone: L� <br /> Physical Address: 1451) Sn5f NvAt'in-r-1 off . f}PnS t'- 153- csO- U3- <br /> MailingAddress: t-z2- N CA �tSacS <br /> E. DESCRIPTION <br /> Type of Discharge: ua_yl <br /> Volume: uvtKncwh <br /> Chemicals: Li4aav c)rsc tree <br /> Circumstances: -r-A4-e- S+e&U5 evalucLt 5-G-'72- <br /> F. <br /> .6.42F. ACTIONJ TAKEN -S 5tcrnt4c 'l&wy-s V2vno✓2Cl r(-fzixrt '23" m(, <br /> �Q$1ly Ur.X CGS 9wttV\�1'lc:�t cnevct U Witt U CtLcc , UL+,Cd <br /> Mfv, ah UAK ru^4adc l-c- <br /> (ro l w thn ca � <br /> S645 <br /> 'e . Fvrrl- -i thuosh�cflo-, r'e to c 1 <br /> (ry� f raJDL e f'II5(er/f� cT�d cvkwCcl3 <br /> SITE DISPOSITION R t al lap- <br /> EH <br /> eEH 22 013 (Rev.4/91) <br />