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` SAN JOAQUIN COUNTY • <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHr*GE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I I III PHS-EH LOG # — <br /> (Circle ne) <br /> B. SOURCE OF INFORMATION <br /> Name: 'J6:1W4,59- 5• /74:4D.5011 9 G. Phone: 2 /D Z37173'0 <br /> Company: M:5f 4-7E 6ko,4 /NC- <br /> Address: <br /> NCAddress: AZ�� G�- o? f`,�o i <br /> Designated Employee Name: Phone: �) <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 50/ 6U. Zc,-4" ,414E5 / Z© <br /> (Best Physical Description) City or County) Circle One <br /> Date of Discharge: U^-rK <br /> Date Notified: 11- 111-F!5 Time: 3 <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: A/EGf3oKiD�s �E�XooEun+, i.VL <br /> Contact Person: MtOL4-s 730,ewbtFs Telephone: (Z� 4 3 -2,n i i <br /> Physical Address: 2,,( 9/ NIX DrC�cl-E S77Xt CA S5Z-a6 <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: UNKeV <br /> Volume: Z)AJXA/ <br /> Chemicals: e5,04-5061 A)6 <br /> Circumstances: 146G< 7- <br /> 9,rv��c✓ �f-sC-� c3oGc.0"G �how� 2 �x� ixoxn roie.o,uzs u/�G[s ausi\r�. <br /> F. ACTION TAKEN /- S, 7-e Ex,-� 8 <br /> 3, tC s ccs, itcovr rdrzi�ua Ao lit <br /> SITE STATUS <br /> EH 22 013 (Rev.4/91) <br />