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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHIME , rO <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: II III PHS-EH LOG # �fJ <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name f S '/ sli .Psi<� s ) f�,� Fµ�//�Y Phone: 9( !�) 3�6-/ �, , <br /> Company T<� /</� <br /> Address: - ? T !.- Cr Su c v 1 f J G 4 i of 2 7 <br /> Designated Employee Name: c z Phone: (Z229COUNTY <br /> Reporting Agency Name: S C HEALTH SERVICEa <br /> Address: DIVISION <br /> 445 N.SAN JOACWN STAiET <br /> C. LOCATION AND DATE OF DISCHARGE STOQIXT KLAN <br /> Location: ;IV S2 • / 5 Ln c E/vti <br /> (Best Physical Description) ry o County) Circle One <br /> Date of Discharge: a� <br /> Date Notified: /.;1-/ /9-2— Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: eti - <br /> Contact Person: Rex Telephone: (a09) Yd� - S Is- <br /> Physical <br /> sPhysical Address: <br /> Mailing Address: su <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: uK/. v l <br /> Chemicals: a3 e/ <br /> Circumstances: Rom;' rQ ".s/ 5. .�t.��ce. .• 6 /u , d' ccv,o lu.c% <w d«w,� <br /> F. ACTION TAKEN To ./e ems. 1-,r 4,A <br /> SITE DISPOSITION L 1i s 7r u c rrr s...o. �L cerj<u— sei �r !t, c <br /> In r, t",o 4 PY/! U� Co n"f+e i++ i....a' ua-. GII !'"et +!/`�� Liv /.��jO�i�U,Oyr ••'�T' <br /> EH 22 013 (Rev.4/91) <br />