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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: 1 II III � \`-J PYHS-EH LOG <br /> (Circle One) <br /> B. SOURCE OF INFORMATION phone: <br /> Name: <br /> Company: ro n; <br /> Address: �f /D ��M i r+o nI L)N SAN ill nit Glc, - <br /> Designated Employee Name: Phone. (20-.-A' <br /> Reporting Agency Name: 5AA1 JOAaUirJ L0 H6/ i At71 S z�KGS-- <br /> Address: n c 15z'61 <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: /D 3 <br /> (Best Physical Description) (City oi County) Circle One <br /> Date of Discharge: b1.1KHyc✓/2 oa All, <br /> Notified: /-2/�2- Time: 4 <br /> D. RESPONSIBLE PERSON/BUSINESS ��q -2 <br /> ¢v <br /> Name of Business: - e✓ i✓ 5 v Ale, <br /> Contact Person: �-74,ujes /lieSfef- / Telephone: (DuS—'7 906 <br /> Physical Address: r�J ln/ // S% u �as�7' <br /> Mailing Address: //J 3 ��/ i/ _S% 771Azti 6A- -72376 <br /> E. DESCRIPTION <br /> Type of Discharge: r' <br /> Volume: u/N <br /> Chemicals vfmv />"a <br /> Circumstances: 55 1 �;7 7`/t�//c v✓a s .'t c, o✓ <br /> /i/ %-c4- 9�? /C /�l-i`�,G' f'/•fC.�SiC'� Sf //v. beC /c19/ i <br /> F. ACTION TAKEN % T/�T/ /C /�/f}S ✓n���i � ,rv° rz<�a✓�� <br /> SITE DISPOSITION ^ /=fA e, b <br /> �F >n/I .✓ a 5 <br /> 4 ° <br /> a <br /> EH 22 013 (Rev.4/91) <br />