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.. SAN JOAQUIN COUNTY �. <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL611 III Cop -EH LOG # 92 - <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: <�11 AS%C/L� Phone: ? <br /> Company: Co <br /> Address: 2 ' 3 C0/0Als;�' civ/ F <br /> Designated Employee Name: FR-1/ /-r>C tA- Phone: ( - 039 <br /> Reporting Agency Name: <br /> Address: 41�45 /�J <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: AEA.1 22 <br /> (Best Physical Description) tty or County) Circle One <br /> Date of Discharge: !/ LinJvwr� <br /> Date Notified: 6 i Time: Z ' <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: -AV -hvKA C 7 r L w <br /> Contact Person: G Telephone: <br /> Physical Address: ! D co,tL (4 v <br /> AWl-� S ,TF /,a/> /us r#-xJ <br /> /uaa!!5 ek- ?aO <br /> Mailing Address: Gvs v4�1L FGFS U4 ?ooh <br /> E. DESCRIPTION <br /> Type of Discharge: �J/bL� id�ieiZ <br /> Volume: /iAJII—PJywA <br /> Chemicals: AS<EziA,+—,' A±S <br /> Circumstances: -754xJv 89,'0i1A >. <br /> ,4-7- +�K LXGAv�i^tea/ <br /> F. ACTION TAKEN <br /> SITE DISPOSITION %'/L/S S/T� �L BE /Mrlf� Tv <br /> cr .+iNra E(� Si rG X7.^1 A�< Fc.eii in S��E ASs� �i� <br /> /rs4 v , ir' ;f'Flo c�1��f� •?-� �E�i".�`�'�+'.TNE T,df �/�i 7'y/eF <br /> EH 22 013 (Rev.4/91) <br />