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I� <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY COPE 25180.7 <br /> A. EMERGENCY LEVElI II III PHS-EH LOG # � - DS-2 <br /> ircle One) <br /> B. SOURCE OF INFORMATION <br /> Name: C!c !- Phone: (�) '?,7-3WO <br /> Company: S 1 Pi1� <br /> Address:_/P0 Bx <br /> Designated Employee Name: rhar/vs rtir Phone: (,:2.-) <br /> Reporting Agency Name: f-' .'tl s tin <br /> Address: ✓Ce7'er :r s ;- c; c--4,j <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 'I Y E lVa<_ <br /> (Best Physical Description) City r County) Circle One <br /> Date of Discharge: �k Nous <br /> Date Notified: : // Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: Mr1-11 f� <br /> Contact Person: r r Telephone: (Z,-4 <br /> Physical Address: rr-z i e%,�c�7t �r� M/c J "sf 9Szc7 <br /> Mailing Address: c�b <br /> �' �ar�, ,�rc �,., off �•�1� , <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: flrvxnJow J <br /> Chemicals: G-ces�'. <br /> Circumstances: -tic 51uT . <br /> F. ACTION TAKEN 4,2%/ Z16, 7,s 0-7' fl1/s c pnrre ,SPP v <br /> /G10r/' Ai7,�Z- -T aW�v, lt <br /> .4i,.��. l+rm fid. _Soy C �tzt�+'.•1�f1J_ a� -fI(r� Sr7`i . <br /> i <br /> S,I{TE DISPOSITION 4W,4/.Z <br /> EH 22 013 (Rev.4/91) <br />