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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DIS`"1rARGE <br /> HEALTH & SAFETY CODE 25180.7L <br /> U i`. <br /> A. EMERGENCY LEVEL:XI III PHS-EH LOGb — <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: a.-o /&ae Phone: 5(c f- fv6 <br /> Company: s— s <br /> Address: vv - N ��30� <br /> Designated Employee Name: oz— Phone: Q&j VLE cl6-9" <br /> Reporting Agency Name: 3 J Pit S <br /> Address: vvs N 7, 4 u ' cE-4 <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: /iva T� C,SE , C , - / <br /> (Best Physical Description) r County) Circle One <br /> Date of Discharge: <br /> Date Notified: -�7-/s -gi Time: 3.-�n <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: <br /> Contact Person: Telephone: ( V7) '.3S- --350 7 <br /> Physical Address: � � / i L > 9L r eL2^ 21 <br /> Mailing Address: �� �_ /�, f �s r i s ca %—,- CA 9 s133 Q) <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: c..,/ Cti, <br /> Chemicals: X /P,ix, <br /> Circumstances-' -,,,,,/�o�a <br /> F. ACTION TAKEN / s' <br /> SITE DISPOSITION ./�i >, <�r � /«Tr /,444e <br /> T6/iis /'4-le. CC'<c r Gi i.'-v. 1�`1P..�in O ..�i Lj i5 ! <br /> i <br /> / ,r <br /> J , !'o64 <br /> D <br /> C C <br /> EH 22 013 (Rev.4/91) <br />