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aSAN JOAQUIN COUNTY ft <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> C, 0) P.71 , Y <br /> A. EMERGENCY LEVEL: 11 111PHS-EH LOG # <br /> (�!Ycle <br /> One) <br /> B. SOURCE OF INFORMATION <br /> Name:_h��FCitiJ kA�OZ61 l`�NS�Ff Phone: (Zug) y6F �Yy2 <br /> Company: <br /> Address: <br /> Designated Employee Name: Phone: (� <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATEDISCHARGE <br /> Location: S2?? G✓. L�.c� Lya-41 / <br /> (Best Physical Description) (islivlor County) Circle One <br /> Date of Discharge: <br /> Date Notified: 3 23 x� Time: 11:10,4, ,11 <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: Ll•�•�. <br /> Contact Person: EAX f 44-u-&— Telephone: (,Q-0) ,M2 -y, 'S <br /> Physical Address: 76 - (!,k4/0 �-t✓ Sto m <br /> Mailing Address: CA 1 yr$?-Og0y <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: <br /> Chemicals: <br /> Circumstance .- <br /> LtJ "T- �v✓* �' 4 <br /> F. ACTION TAKEN .2U t .� 5 � .4- as <br /> SITE STATUS 1%4 <br /> Y <br /> vH 22 013 (Rev.4/91) <br />