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SAN JOAQUIN COUNTY T <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25130.7 <br /> A. EMERGENCY LEVEL: (I)[[ III PHS-EH LOG # <br /> (Circle One) <br /> 3. SOURCE OF INFORMATION <br /> Name: Phone: �c X07- 2608 <br /> Company: �?S Ca <br /> Address: /7 S/ STvL�f.�9 � 2D �c RSCS �fD 70 / <br /> Designated Employee Name: Phone: (_) <br /> Reporting Agency Name: <br /> Address: 44 A/ S-4;N S CS vS.V 5-7 i S 2SZo r <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: So/ trr �'' e—',, 4W Goo= <br /> (Best Physical Description) r County) Circle One <br /> Date of Discharge: 5vnlE /'1 47 'f Z- <br /> Date Notified: AV /8 /99Z- Time- 3' �wI <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: / - ^ '�?/L e/�F-zx lDi`sP��Y <br /> Contact Person: Telephone: (gbD 4/07- 26oc� <br /> Physical Address: / 73/5 5T11-092SIlS,6;e RQ- a4 `15"l <br /> Mailing Address: 173,-5 A?2D. GBee 2TUS CA 9s'Zo,[�_ <br /> E. DESCRIPTION <br /> Type of Discharge: 5P/GL <br /> Volume: <br /> Chemicals: -oma AAI <br /> Circumstances: G/G '77 <br /> �F�OQT'�SG47 S£. <br /> F. ACTION TAKEN 62a <br /> _ �i5.�r-•v5 � 7 S /d�to �+�i.+t`'i-E�L�9cE i�ifs .P.CPA•2-ie�✓, <br /> ice'^ G,�d,C.r�✓crr �i�E-�✓SE� So�'s� Sra�L c�iJ`7"iQ�`+..Z�/+4?iaf J <br /> SITE DISPOSITIONy/L�ii/oc�ri/ zF /d�l� �i'G/ soi e - <br /> Cox/f�r13c/�� <br /> EH 22 013 (Rev.4/91) <br />