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A. <br />a <br />C. <br />SAN JOAQUIN COUNTY <br />NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br />HEALTH & SAFETY CODE 25180.7 <br />EMERGENCY LEVEL: C1 11 III PHS -EH LOG # <br />(Circle One) <br />SOURCE OF INFORMATION <br />Name: <br />Company: G 0 tl /, s <br />Address: i„ 3/ Eur sk s A <br />Designated Employee Name: C-0,0/ <br />G v <br />Reporting Agency Name:, Joa o <br />Address: yrs n.J. Su�7o�u;- <br />LOCATION AND DATE OF DISCHARGE <br />Location: 400 S. <br />(Best Physical Description) <br />Date of Discharge: <br />Date Notified: _�/,z/r -I- Time: aOM <br />Phone: .S7,> J poo <br />Phone: (2ff)_ /lo jvy <br />City r County) Circle One <br />D. RESPONSIBLE PERSON/BUSINESS <br />Name of Business: /: -,/ / ,1�� e 6nnse s <br />Contact Person: / « c Telephone: (_W - A,-3 -7,w <br />Physical Address: S/? k"&- Sol /^A-X-,� -D� z rsul oy Y S0C4 `/-l�// <br />Mailing Address: `divnF r, S - <br />E. DESCRIPTION <br />Type of Discharge: L4,,?au�6oz,zz-/ <br />Volume: <br />Chemicals: Ae, <br />Circumstances' 5&i/ s n/ s K" A vn �weiyG.-P <br />F. ACTION TAKEN nyW (.1A2 a /ra�- <br />szrrn�_ <br />EH 22 013 (Rev.4/91) <br />