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i/�uvo 12 <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: IQII III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: / G Joh Phone: 3( ro ) 4/07- 060 <br /> Company: <br /> Address: 4 �s� <br /> Designated Employee Name: Phone: (�) <br /> porting Agency ame: <br /> cess: �- I - s4 ia44��s s-rz�c -roR( c_4 `�SZo 1 <br /> C. '_ATION AND DATE OF DISCHARGE <br /> ation: <br /> (Best Physical Description) (City or County) Circle One <br /> ate of Discharge: 8/304 �2 <br /> Date Notified: 3, Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: 4ie,-_o <br /> '� � / <br /> Contact Person: ?'.. l O4 Telephone: 3io 5l07- Z6o <br /> Physical Address: <br /> Mailing Address: moo• aoX 6c, -S3,, 7o2-6038 <br /> E. DESCRIPTION <br /> Type of Discharge: . q=/12 <br /> %rc <br /> Volume: �/Z �a <br /> Chemicals: !/n GEA/LES G45ct-2 <br /> Circumstances: 6-1. <br /> A S��`' /� r' .��in Zn�✓�i � <br /> F. ACTION TAKEN v- A. e. <br /> SITE SnnTATTU/S v. Z�nI 0 �Bi d <br /> EH 22 013 (Rev.4/91) <br />