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SANJOAQUINCOUNTY FILE COP ■ <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG# 03 —0 2 <br /> (Circle one) <br /> B. SOURCE OF NFORM.ATION <br /> Name: <br /> t/lfm\ Phone: (M �✓�S . Cll-Y>C) <br /> Company: S <br /> Address: 3D'7 <br /> Designated Employee Name: Ln A Phone: 9•3 <br /> Reporting A enc} Name: �n... �u GrlyiYb✓1 �{L6�rtL DCD Ytb+ <br /> Address: &L 'EA W 3 YKD^�" C >m Ct A Glc,20Z <br /> C. LOCATION AND DATE OF DISCHARGE <br /> 145 IV �lvave+ / b tDG ttM <br /> Location: 7R[7 C.hP-n he Q i or County) Circle one <br /> (Best Physical Description) <br /> Date of Discharge: <br /> Date Notified: 5 Time: 2:ODS_ <br /> D. RESPONSIBLE PERSONBUSNESS <br /> Name of Business: &UMMA IYW Y f� <br /> Contact Person: Phone: ai (414U. 120 1 <br /> Physical Address: u 1 <br /> Mailing Address: }?b 130X <br /> E. DESCRIPTION rr tn \\ <br /> Type of Discharge: <br /> Volume: �— <br /> Chemicals: <br /> Circumstances IUA n& Y <br /> 53 Ost V C¢F <br /> F. ACTION TAKEN 1 Y.nl M+cl 11Aa� " ' ^rlpv <br /> -moi {i/vm tai l Soi lwas <br /> SITE DISPOSITION <br /> EH 22 013 (Rev.08/20/98) <br />