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SAN JOAQUIN COUNTY — r. <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE (nl � <br /> HEALTH & SAFETY CODE 25180.7 0 <br /> A. EMERGENCY LEVEL: 1 11 III PHS-EH LOG # <br /> ( rcle One) <br /> B. SOURCE OF ORMATION <br /> Name: ,0A � s/ �'fl G-� Phone: Vtj) <br /> Company: <br /> Address: 6 CU S Toc INTO <br /> Designated Employee Name: A- - Phone: �3�fZc <br /> Reporting Agency Name: .',a ✓ O / /a (f7C <br /> Address: T <br /> C. LOCATION AND 9ATE OF DISCHARGE <br /> Location: S7Gri�fdh (-I <br /> �SZL�l <br /> f �/J/� /l�, ��Gni / f <br /> (Best Physical Description) (City or County) Circle One <br /> Date of Discharge: V tj k rent i ^j _— <br /> Date Notified: / 2- - 31 Time: b'' J U /6-� <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: <br /> Contact Person: e Telephone: VaD —Z-0 <br /> Physical Address: 16 57D,7 IV i/" i✓ S 42c. �fi e--A- <br /> Mailing Address: G 9S <br /> E. DESCRIPTION <br /> Type of Discharge: VA z <br /> Volume: J <br /> Chemicals: e vti. % V C C..4 P S <br /> Circumstances: a ✓gid i <br /> 5/-7.n e✓e.�y/ ero'l✓'fAyr iN 74/ON <br /> F. ACTION TAKEN tt /O //0 A/ <br /> O//rrG� /C ✓mss <br /> YeAna a--7- <br /> it o 6U✓.ue._ <br /> SITE DISPOSITION i Bim- Gv%LL <br /> q11VA - - tib -c e, <br /> G <br /> EH 22 013 (Rev.4/91) 0 <br />