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SAN JOAQUIN COUNTY <br /> NOTIFICA'i iON OF HAZARDOUS WASTE DISC:;dtGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I�I IIIP,HS=�H LOG f)3 <br /> (CIr le One) <br /> B. SOURCE OF INFORMATION <br /> Name: Phone: (� 6L4- 9(p53 <br /> Company: co <br /> Address: 431 �4/ t,ck �aFn� <br /> Designated Employee Name: Phone: C__j <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 1"105 1J• Px2ol Lwl / t <br /> (Best Physical Description) (City or"un One <br /> Date of Discharge: <br /> Date Notified: 10r 51 q'Z Time: l •QO�v+� <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: _41�nabs• �• SCs�t u�lL� <br /> Contact Person: , Wei-)awl C-e4w gat. Telephone: ( n�) G4li3 -;- R50 <br /> Physical Address: 170-S 6J �nlsyfi" - <br /> Mailing Address: Spsmg' <br /> E. DESCRIPTION <br /> Type of Discharge: I1,ti: AXn= 11121zi1 <br /> Volume: <br /> Chemicals: (�alcut taJls' <br /> Circumstances:_ bNyvqYW1U4TUM tysf7kl4� CJt+Qn�t� +L (C ovka2, <br /> -P ,) C svt G��ttC�� t 0- l <br /> F. ACTION TAKEN <rv� U v►�� w�ta�w�bom oA� sro2Easd asst s�As� � <br /> QPM r Paces y6�') 1;7 t� - s�� ess6�ss�grr' c.tui <br /> -�"��:0�1 Rau C�AA2o�ofLi.>�' �sG�iwbcr, yb �•M*r�f cI►d.c- <br /> � tY�•(`n r�� OFA ,o(,-rxL�s- aG c`�1�—Ps+.�,6wfaGl,rn - '--- ' <br /> SITE DISPOSITION �Lv t s,. ioiln 'TAl a� <br /> ��tact toitcs,�� n � i �, ✓ ��axl --rte ol&>.- �.�croJaat�' <br /> EH 22 013 (Rev.4/91) <br />