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SAN JOAQUIN COUNTY <br /> NOTIF[(!T'rION OF HAZARDOUS WASTE DIS(v.HARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL::II III 0 FIYP <br /> HS-EH LOG # / oC -7q <br /> ( in le One) <br /> B. SOURCE OF INFORMATION <br /> Name: w d-17� 41 ( '9 -7 Phone: (�)I-23-1.3 4 b <br /> Company: <br /> Address: CvA qt <br /> Designated Employee Name: Phone: (_) <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 553 5 . At r 11C-I- LJcuq_ • / C4k- <br /> (Best Physical Description) (City or ou!t Circle One <br /> Date of Discharge: <br /> Date Notified: 1> `t I Time: 3 t bo 0. <br /> D. RESPONSIBLE PERSON/BUSINESS Name of Business: cu Abs <br /> Contact Person: Fo C 1C, Pt r, r Tele hone: <br /> Physical Address: 550 3 5 c r 1A `p1z�Kf� <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: Lu,� <br /> Volume: <br /> Chemicals: u ¢ems Ga`� c ' ¢- <br /> Circumstances: Ve-v ( e.< D- .5 a- e 'e s u 4-s o 1v <br /> d-',uA� U5' 1\2 tis �P <br /> F. ACTION TAKEN <br /> SITE DISPOSITION 1k 5` <br /> EH 22 013 (Rev.4/91) <br />