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1.01 �'no <br /> SAN JOAQUIN COUNTY PID <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARG �. <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCYLEVEL Il III PHS-EH LOG # /� O J� <br /> ucle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Phone: (__j <br /> Company: <br /> Address: <br /> Designated Employee Name: -tUmeta 5 ! Phone: <br /> Reporting Agency Name: <br /> Address: '4�65 /�l• < dlt u �� 6 695202 <br /> C. LOCATION AND DATE OF DISCHARGE L <br /> Location: /x/07:'• W. <br /> (Best Physical Description) Ci r County) Circle One <br /> Date of Discharge: Lei✓en4VJ'') <br /> Date Notified: 3-9-1314 Time: Z:0-v .RM <br /> D. RESPONSIBLE PERSON/$USINESS <br /> Name of Business: C 14. 1 Q-f 574GKv�m <br /> Contact Person: J641', �iy/GVYw6" Telephone: (r-of X13- 89z` <br /> Physical Address: y25 N. 65:rI Dorado Rar 3)� 1 66gdm C� 95211? <br /> Mailing Address: �ISQn-vle.. <br /> E. DESCRIPTION /�K 7/vry1 'U J57— <br /> Type of Discharge: <br /> Volume: U-nei✓� <br /> Chemicals: <br /> Circumstances IkL"//aa <br /> F. AY <br /> IOhN TAKEN / � U&STzi/v <br /> 41A <br /> SITE STATUS ! %/ <br /> r <br /> r <br /> v W <br /> EH 22 013 (Rev.4/91) <br />