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SAN JOAQUIN COUN= <br /> vC-'°-C-=_70N OF _°ZaRDOUS W=:-- u <br /> J=-ALTri & SAFE CODE 25180.7 <br /> EIM RGENC.' L VzT II a: PFS-E:i TOG -,-' O�I <br /> CCi.`lie One) <br /> B. SOUtC-7 OF rORMA'_'TON <br /> Name: =2 / U/ r�'/e / Phone: L1�J TT 7 <br /> Company �JS� <br /> Address: 6U <br /> Designated Employee Name: Phone: L.) T <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION A DAM c� OF DLS GE �xv <br /> Location: / Z N �G J�( / �� ., <br /> (Bes Physical Des=-pdon) G "r Cc=-ry) Cade Cne <br /> Date of Discharge: N �//�/✓ <br /> Date Nodded: 6-lel-`1 -='" Afn/ :z - <br /> D. R=SPONS=Z ?ERSON/5L'SEN.SS <br /> Name of Business �: ;1 /u7�i 77/lC�� Z-606J 6 & <br /> Contact P---sol: " LO <br /> Physical Address /JPG ��'b CL Pd /ao n SLE Cit 956 i <br /> M2 a-a Add---ss: <br /> E. DESCRTVTION <br /> Type of Dis=arge: Ll/JC'X1Wa,1 / <br /> Volume: U.UK W6 )kj <br /> Ch=*tricas: • ti <br /> C:rcumsranc�: .� f6s 6 w - � U 5.T <br /> s <br /> ACi ON TARN — =/�') d3 GDIt lam/ <br /> d 5� -t x <br /> UST' <br /> �� 013 CR_Pv.c/ol) <br />