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SAN JOAQUIN COUNTY ../ O D <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE O p� <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:(J7II III PHS-EH LOG # 2Y ZO / <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: -77^ �?l e/� o��= Phone: (ZW 67b- Seo <br /> Company: A,,efc <br /> Address: P c;'• aO v &035f c.¢ 9r' 7oZ - 60 38 <br /> Designated Employee Name: Phone: (_) <br /> Reporting Agency Nae: <br /> Address: ��/1 ^I- Cd � i Qyr iia 'fir 4 S2v <br /> C. LOCATION AND DATE OF DISCHARGE ' <br /> Location: /.4'9'70 G'oc�c2 S> �QfrBr+l� / Glir-cam /�•er d <br /> (Best Physical DescnpnoCi County) Circle One <br /> Date of Discharge: <br /> Date Notified: 4 Time: y: yL/�wi <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: Alco <br /> Contact Person: %• Telephone: 'Ery G7o- c� <br /> Physical Address: iJ o. i?o 0 3S ,- 070 - 6o 3k <br /> Mailing Address: P o. 13o )r 40 38 �sr c9 40747 -6D �S <br /> E. DESCRIPTION <br /> Type of Discharge: vrr r Gc4�E <br /> Volume: <br /> Chemicals: ri4e2) Cr9So� r= <br /> Circumstances: Ag2cz> -HE'D 7 r <br /> r� r r i/G7 Std / - Q CV• A. I� �� / <br /> F. ACTION TAKEN !� 'tel o/cam �il� 5. Tc' —T�rdAEr�{T <br /> C -7- <br /> 4>j <br /> h47��Br�4 rd D -aie= <br /> 2 r o 5--, rt=SITE STATUS -726- <br /> EH <br /> cEH 22 013 (Rev.4/91) <br />