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F-1 14- <br /> - SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 C� <br /> A. EMERGENCY LEVEL: Cbi III PHS-EH LOG #� <br /> (Circle One) <br /> B. SOURCE OF INFO TIO <br /> Name: fJ Jc- Q�`U Phone: <br /> Company: l�L� <br /> Address: %"D• �� n38�_ ,e`7�£5T <75o O <br /> Designated Employee Name: Phone: (_) <br /> ReportingAge " N�tne: <br /> Address: �% <br /> C. LOCATION AND DATE OF DISCHARGE � <br /> Location: /8'17li <br /> D acv �40 SA ,, gl r-ra__ 40 / 5744 <br /> (Best Physical scription) (City or Circle One <br /> Date of Discharge: f2'4-4 3 <br /> Date Notified: Time: !: oo ,o n., <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: 1A P—G D <br /> Contact Person: c Si4 Pz_ o Telephone: (:Sa7-2-60g <br /> Physical Address: <br /> Mailing Address: t3oX 6D 3 Fs, /cry X70 7y7_ -6 a3 <br /> E. DESCRIPTION r <br /> Type of Discharge <br /> Volume: Z G <br /> Chemicals: Som <br /> Circumstances: <br /> F. ACTION TAKEN /Q����%�//J/G/TE�" TiilE S/JiGGE/� �iGroL✓NE <br /> .�lJ �6GcseG jT �04-4 I3C GGG4 E� u <br /> SITE DISPOSITION <br /> EH 22 013 (Rev.4/91) <br />