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TANK <br /> SAN JOAQUIN COUNTY <br /> COPYOTIFICATION OF HAZARDOUS WASTE DISi!�iARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:d' [I III PHS-EH LOG # — I V / <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Phone: o53s <br /> Company- <br /> Address: <br /> ompany Address: <br /> Designated Employee Name: JERRY YOSHI ,ORA Phone: L468-0335 <br /> Reporting Agency Name: SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH <br /> Address: 304 E. WEBER AVE. <br /> C. LOCATION AND DpTH OF DISCHARGE <br /> Location: 35S I u-c,c.t <br /> (Best Physical Desciption) (�or Couziry) Circle One <br /> Date of Discharge: <br /> Date Notified: Time: i55c oti�5 <br /> J <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: ��c: <br /> Contact Person: Telephone: sz0 c�z s-4I s 32 <br /> Physical Address: 3G,�kIT �, cKbass� ,u� <br /> Mailing Address: 13� y1 /l L't�iLxtSS�t �r c Tuscon /3� �5�3� <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: <br /> Chemicals: c I <br /> Circumstances: G\�,L- S\ rrr� you cz, _ <br /> F. ACTION TAKEN ��� C d �,(n Fc — ��« —E �� �c� - 0. �sis • _ <br /> SITE DISPOSITION bG r:e0uiv-cd /✓ -4L- <br /> ELI <br /> 4 - <br /> EH 22 013 (Rev.=/91) <br />