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• f <br /> 14W. SAN JOAQUIN COUNTY .Me r <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: ( )II IIIo �/ S-EH LOG # <br /> (Circle One) UUU <br /> B. SOURCE OF INFORMATION <br /> Name: Phone: (Z// 3j,/ 3,(73 <br /> Company: U ?(c,? - <br /> Address: s�� /i 4-, S-r. 77 s ,r 7;7a v <br /> Designated Employee Name: Phone: y!.f - 3v <br /> Reporting Agency Name: ( cam /- <br /> Address: vNt n;, ��� ��<�U �- rL <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 3 a 33 z-00 � s HCl <br /> (Best Physical Description) ity r County) Circle One <br /> Date of Discharge: /e,��m <br /> Date Notified: /iU/y, Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: - <br /> Contact Person: Telephone: ELD <br /> Physical Address--T.-23-3 <br /> Mailing Address: m e <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: <br /> Chemicals: <br /> Circumstances: �(%(<y of 3/ceP , /(1v {v au ss /:•, 1c5� . <br /> �f y v clue re (c ce <br /> F. ACTION TAKEN L o.v alve a,4s <br /> SITE/DISPOSITION <br /> Ali/(dmiaL[.Tic pOil-� <br /> /7, S� �<c�t. ,ry7L <br /> /7iln��-.�1 �/ r..:aJ ri✓�,x-�.r C !"r G 41 hP5 �t1/�fL.�. /t SLP SSyv.a e.�". <br /> EH 22 013 (Rev.4/91) <br />