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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: II III PHS-EH LOG #--f,9 <br /> ,2 <br /> ( ircle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Phone: (jEZ) 66 F- '-IZ35" <br /> Company: Con o/ S'cr �rL � �ogies Inc - <br /> Address: it ZS /J. Gml�Qe� SAI k CF. <br /> Designated Employee Name: Phone: (zo.L)v6rr-o331-/ <br /> Reporting Agency Name: S4� �oa� „„ C. <br /> Address: `-1 Ll S N. C,.6 kk0.,, C, 95 zce— <br /> C. LOCATION AND DATE OF DISCHARGE / <br /> Location: zz o ©4 le �a� k c 9 <br /> (Best Physical Description) r County) Circle One <br /> Date of Discharge: _ �,i Enow� <br /> Date Notified: f-1-7 — 5; Z Time: 9"' 3D <br /> D. RESPONSIBLE PERSON/BUSIN SS <br /> Name of Business: _�',_1f wlAA�Cc9 } ©�� Ycr� <br /> Contact Person: Po-Oe3\-c, Telephone: zD '23 9 a Y6 2- <br /> Physical <br /> Physical Address: icer Cep / 54. � M4., r4 Cg 95 3 3c <br /> Mailing Address: e- <br /> E. DESCRIPTION <br /> Type of Discharge: frr,o�for L �e �essco,+� (� r�rc✓vtor �K <br /> Volume: v�1 kvlovv� <br /> Chemicals:` / ,� , e r—�C e a 4 0 c <br /> Circumstances:��,cow Vik <br /> 4 v S r ir�ov. <br /> F. ACTION TAKEN_ (mss vnuO��S/ate �r/e S /arm /��� .✓mss <br /> ion v l 2LI, 155P ana 1Y5 1\ <br /> I A 1 Ge . n_ ✓./� <br /> i✓JN/9 .n <br /> SITE DISPOSITION <br /> EH 22 013 (Rev.4/91) <br />