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'11 'e- <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE- <br /> HEALTH <br /> ISCHARGE -- n <br /> HEALTH & SAFETY CODE 25180.7 0p <br /> y <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: U L C L✓: /t/N S Y Phone: 393-ZZ/ Z <br /> Company: ASSOGL&ba ri+ay l C'o ti ��NT7 s-�5.M's"S Zp/ <br /> Address: D go X $4f/ Z e-* -9gp <br /> Designated Employee Name: i-fPhone: 9-e!j) ',6r-3,12 <br /> Reporting Agency Name:s' NTmgf a0 (n . C,,6 Inc, 1 -4XC;* 2;1LVIC&4 C t}jf-) <br /> Address: 6z. �o D STg c k4xin <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: '"75-00 W <br /> (Best Physical Description) (City or Co ty) Circle One <br /> Date of Discharge: UNkv\4� <br /> Date Notified: Time: 1 , o Url <br /> D. RESPONSIBLE PERSON/BUSINESS ^ !,/"� <br /> Name of Business: -TzN-,r- �p -rp-g-,jtc i-- OA-Z,6- <br /> Contact Person: F_ SoK (aA e> 9- Ni hone: (� 3 ZO// <br /> Physical Address: _21 °1 1 Npwx fD2 1 o iGtdes <br /> Mailing Address: 5A71yl P <br /> E. DESCRIPTION � � <br /> Type of Discharge: <br /> Volume: Kvt v <br /> Chemicals: Pe-ft v1rtovv% �7 Av�nc_-P,6vwS <br /> Circumstances: A-4- OP— \4A-0p ?- L/NPS' <br /> . *L i r, tiJ �'l 1G c� <br /> mel U sT. U <br /> F. ACTION TAKEN 1/I.V-v.�e- f <br /> Cvi -z- / I �r�f►�v_ �'� /�I�cessAl= l i A-ry J� <br /> SITE DISPOSITION --T; pCo <br /> rn e <br /> -7rsL,fJa a,pproraa-te,a a is tz <br /> EH 22 013 (Rev.4/91) <br />