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Now, SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE 1 �� <br /> HEALTH & SAFETY CODE 25180.7 —� <br /> A. EMERGENCY LEVEL: CL'II III CQ vS-EH LOG #��v /CSC <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: /f 7 fl�� :,c,'n Phone: LC 3,7 <br /> Company: <br /> Address: i,o %✓ <br /> Designated Employee Name: 'ircra w+ ! Phone: L/ 5/6rC-- 3y <br /> Reporting Agency Name: 5a,1Covo 1v <br /> Address' 4q S1/ = \occ��In <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: /O c C�f> S- i/G• / <br /> (Best Physical Description) (City o ounty) Circle One <br /> Date of Discharge: �� :)�L✓'' <br /> Date Notified: Time: r <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: ^.a,7 k /v.,SJr✓civ �o w.7, <br /> Contact Person: <oy jG sv 'c Telephone: z61 ?52 7 s c <br /> Physical Address: <br /> Mailing Address: /e, 130y / 5/ <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: <br /> Chemicals: <br /> circumstances: <br /> 7�'✓� �ii6 VVAG/ c"�/SSL �'.e rifc�c1� an <br /> 7 Z—r/ (�c.7/GiRii7G(7017 ,�o(v`weo IeO ,n ,ii-eJi I- <br /> S <br /> - 7 <br /> F. ACTION TAKEN <br /> J/ �' fim- do s ry✓vim fro/ <-i S �oo�� ✓� <br /> 4f 7 sfl�s.K /. L✓c/SCG - ✓�/ T/c 1_ <br /> / fir/is7'r tL t PX)ern f' sem— <br /> SITE DISPOSITION '4 ii-a/ fv /—� <br /> EH 22 013 (Rev.4/91) <br />