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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE ®� - <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:01I III F11 <br /> PHS-EH LOG(Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: G ah a l Phone: (dc )� sa 7-Q9 na <br /> Company: <br /> Address: ✓� u s G s /� _ <br /> Designated Employee Name: CK / 0 Z— Phone: 09 91, P vG Y <br /> Reporting Agency Name: S oa o u .n /', 6//� lL" IJ6 .$er v,ces <br /> Address: 4/y> v 5g, <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: ;1 / 0/ E. <br /> (Best Physical Description) ( i r County) Circle One <br /> Date of Discharge: <br /> Date Notified: 3 -31 - 7a1 Time: ?Plr2 <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: Sa/es <br /> Contact Person: CPQ.-; P .^ Telephone: 9 v -io <br /> Physical Address: _ 95- 51/, C-0 9,3---Jo ? <br /> Mailing Address: c�/p i t. C A a r l e, &-.) a Sfv k C,2, C,4 <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: _i,d, 1,,,2&, 11 <br /> Chemicals: X, /P..P bH / /P, <br /> Circumstances: va-4 <br /> F. ACTION TAKEN M FK d- P/^ne to: %/ed aao¢t�4 ccL4 tr/A Ju <br /> be SPof A? O� )il4-1 <br /> SITE DISPOSITION _)t7�LcfAg < :Lv a ssresH.a�� &0;11 be �2CPSS4�i fa <br /> -n4! I An l;V --�' rt bU o J- P v LPn-� c� Coir�c , !,'did)') as i-? M <br /> EH 22 013 (Rev.4/91) <br />