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SAN JOAQUIN COUNTY <br /> NOTIFIC,^ -I <br /> rON OF HAZARDOUS WASTE DISC.. RGE vv <br /> HEALTH & SAFETY CODE 25180.7 L ` --- <br /> U <br /> A. EMERGENCY LEVELI III PHS-EH LOG # k — <br /> ( �rcle One) <br /> B. SOURCE OF INFORMATION 7Z, rbc <br /> Name: �Frl/�l�f�'24/ 4 l� ie/� Phone: &2 S <br /> Company: <br /> Address: ld>31 <br /> Designated Employee Name: �JelGli�N �_ Phone: <br /> Reporting Agen�c,Y�Name: <br /> Address: ��l7 �✓ � �1 �t� r —950/ <br /> C. LOCATION ACJ DAT OF DISCHARGE <br /> Location: / 3 <br /> (Best Physical Descri tion) / (J�r County) Circle One <br /> Date of Discharge: <br /> Date Notified: Time: 3 7,907A,& <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: <br /> Contact Person: 1Z&,dAA/ - Telephone: W-4.2 <br /> Physical Address: <br /> Mailing Address: Z�o 1 699ff-6 &,Z/-/-/ ST- !Mk) F ;./G/ <br /> E. DESCRIPTION <br /> Type of Discharge: G�1 / ie'7� f/� <br /> Volume: 4ZLZAr.�] <br /> Chemicals: Lv4-!�o4,I,NIF . z,, 5Z ai <br /> Circumstances: Way F-,?v oG sr/L �CsvG7 S �i�j �A 1V/C 2 EJ>ov.4 l� <br /> yNDiiiQ?7 -,iowG <br /> F. ACTION TAKEN ,^ ✓D 2Gf��vNa ��.2,gcS� �T'.9 /V/L cr�E.Q� i2E t1di� <br /> SITE DISPOSITION / 5� a�FT�J �I//JET/Gx/ cr /LGl3F i���v�ENTEi� <br /> Ago gnonty--Ae-�jNA7r� srZr <br /> P�/d�l1 R/dSF FaR?7 v�rr-/1s 7'lbc/ �J. c <br /> ,�� !3 i P Eoc �/✓',� �'r� d' .� .9-iVn ,F r v Ns � � <br /> EH 22 013 (Rev.4/91) <br />