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,� SAN JOAQUIN COUNTY ..e <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: II III PHS-EH LOG # <br /> Circle One) <br /> B. SOURCE OF INFORMATION �7 <br /> Name: Pte. 12 �h flied Sc lav/ �sT Phone: 3/ <br /> Company: tea. Lp - <br /> Address: 30cl4 c on <br /> Designated Employee Name: / Phone: (,Ly) <br /> Reporting Agency Name: r <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 3011 N, <br /> (Best Physical Description) 0ity r County) Circle One <br /> Date of Discharge: <br /> Date Notified: !o%a, R/ Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: 6,' ri�L L Lwd/ />>s�rr� T <br /> Contact Person: v'P c21/ Telephone: <br /> Physical Address: 52;,17%a <br /> Mailing Address: sure <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: 1"11 /� <br /> Chemicals: c so/r-�p , c/.P sel <br /> Circumstances: / al,5 , /, 6�_.� y <br /> wr(7 a4 t5)en.s i 421, 17,;, - <br /> F. ACTION TAKEN <br /> T -/r> <br /> SITE <br /> //DISPOSITION_ // cy. e t <br /> /Pr� r7-C Um✓hi��, r � �tu.+ �/J � u Cy��c.,. ,.-�.f,� J/'U J�/tS_ <br /> EH 22 013 (Rev.4/91) <br />