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* • SAN JOAQUIN COUNTY • �O'(=� <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE UUU <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: 0II 111 PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Phone: ro 795-16ZD <br /> Company:- GA�,Pe,EGG <br /> Address: /(o Zde—kx vE So 37 , Ez—� <br /> Designated Employee Name: Phone �) <br /> Reporting Agency Name: <br /> Address: .I(. ;i—, . s ti_ A �S,a <br /> C. LOCATION AND DATE OF DI�SSCHARGE I <br /> Location: --,0P 7 /a <br /> (Best Physical Descripption) �r County) Circle One <br /> Date of Discharge: z/-AK�lowt j <br /> Date Notified: 9/iz Time: SZ:3o a. <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: <br /> Contact Person: res r Telephone: (Zn) 9 /- o`PZ <br /> Physical Address: S-raCZa <br /> Mailing Address: 7a Cameo rc. s 95 0 <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: v ,l. rc��,y,j <br /> Chemicals: < vE <br /> Circumstances Sores Z�sr�e �S pr <br /> —T-Ai6 v 1. 7-;' <br /> �1 <br /> F. ACTION TAKEN !i�lgE,1C.,�'ov i[s; gso,2q �V�i� Geds ti D <br /> SITE STATUS 2 S. A-2-> <br /> -- <br /> 0 <br /> EH 22 013 (Rev.4/91) <br />