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..� SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> 'J <br /> A. EMERGENCY LEVEL: DIII III <br /> PHS-EH LOG # LA — <br /> (Circle One) <br /> B. SOURCE OF INFORMATION Phone: zE ) ��� <br /> Name: U✓0�� ����` <br /> Company: <br /> Address: 12- (L wftiT F_ ^ S fii 1J G'( �lbfs-3�I�q <br /> Designated Employee Name: -41 �1'�y Phone: (�_T <br /> Reporting Agency Name: <br /> Address: tea �o� Zoo 5�oG �To�l G/d pis 2� / <br /> C. LOCATION AND DATE OF DISCHARGE �Pv <br /> Location:_,: ;'tea <br /> (Best Physical Description) Ci r County) Circle One <br /> Date of Discharge: 1 Nlouv�l <br /> Date Notified: iAv<T /15;1 , Time: =v zd ~� <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: elf-�/Z-, `l/4, 1 <br /> Contact Person: .41 ! !+°Eicl Telephone: -5&f7 q <br /> Physical Address: 4i-;Wo 4 <br /> Z, � �� � AZ .4,0,9 `-lr- 45 '2-7-6) <br /> Mailing Address: G!57WP G `f�11(44"Eq'11 vol Pa cod `�`�Z�o <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: U/Yl�NawC�/ - <br /> Chemicals: Bf�zE.v� rowFrrF GrN('Gl3Lhlz�c/� kYc�ur <br /> Circumstances: AgvrF4{-2 oG sari �2r4v�T�, ,c�a�4 `r �,Q�vvvi4i <br /> uVOil�4`TF C�T�lNod�'!oN <br /> F. ACTION TAKEN -IXA(9 <br /> SITE DISPOSITION c-anCrdLIA1 K r1oxf9E <br /> !%d/Z -7-0 <br /> r3 - <br /> c2y P'/ f tFD v recv mi B <br /> EH 22 013 (Rev.4/91) <br />