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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISGC'irE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:OII III PHS-EH LOG <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Phone: <br /> Company: <br /> Address: y2z w�=c3� <br /> Designated Employee Name: Phone: L� <br /> Reporting Agency Name: <br /> Address: �57 <br /> C. LOCATION AND DATE OF pISCHARGE J <br /> Location: <br /> (Best Physical Des c 'ption) (IZ or County) Circle One <br /> Date of Discharge: -- 9 3 <br /> Date Notified: Z7/a g � Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: S• - SE,2v/ <br /> Contact Person: Telephone: Com) 9/3-0653 <br /> Physical Address: z 9y/ :n-4 4S�o6 <br /> Mailing Address: 24 41/nl�9y iJ.QiyE 5 u �a 9�zv <br /> E. DESCRIPTION <br /> Type of Discharge: 5GiGZ, <br /> Volume: � �Soo G /oma S <br /> Chemicals: Pr c G FvE� <br /> Circumstances: --aJ4Gr ���:,F.E/, o.E_S. ��,�� „�'Sn(�Kr/��iroA <br /> vl�+FrE,o .�r�'JsF <br /> F. ACTION TARN S�/GGE� FvEG ,eEst� i%Qd�y .4 s�oKE� <br /> 5447— . ZA <br /> 1:527nl2l�s /4;v9D✓F 45reDu O <br /> SITE DISPOSITION o,5 •Tc -r.d�c <br /> ,QB�EyGs E _ o ac ic.(cnl A c / z/�2 po 4iA�L <br /> G/ i &44 41' ARO/-f f/46- t5;�Z6 4>142 z Z <br /> EH 22 013 (Rev.4/91) 0 <br />