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� AT <br /> • SAN JOAQUIN COUNTY • <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 C Py <br /> A. EMERGENCY LEVEL: �I I III PHS-EH LOG # ` � <br /> (De One) <br /> B. SOURCE OF INFORMATION <br /> Name: LA Mv Phone: <br /> Company: C,6PtjEn✓t v dyt <br /> Address: ZO25�0 b. U.2✓oyto✓tJ- Y SJtk- Z5 b Tct-v nce C,4 gogbZ <br /> Designated Employee Name: Phone: (� <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 401 Pcv-M �utn <br /> (Best Physical Description) C ty r County) Circle One <br /> Date of Discharge: V v%o0J vl <br /> Date Notified: a-24-r-t Time: Ip : 3o A-M <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: 05 CosA <br /> Contact Person: tsI't US Telephone: (!15)q'Etk 56'12- <br /> Physical <br /> 5'12Physical Address: X325 Ma V-ff 5t filst Roy. 9f�� Rr.,resco GH 4�[[os-z <br /> Mailing Address: 5r-t^2_ <br /> E. DESCRIPTION <br /> Type of Discharge: 0yAKnc-/J,/) <br /> Volume: U v.K-nu!� <br /> Chemicals: To efvcl2Uv t Pry&voC(tv-bqt!:) <br /> Circumstances: Reutew c4 Irnut-fS Std 45se55vxn�d (lepe d <br /> ( tcl 8.14.4 ( ctt-s( grzpo„zd ho CARE £n�tvo r><anl�C� <br /> F. ACTION TAKEN <br /> 5/E cwtll r2RUO% - cc. J-cu k:. Y-tk-,LJJoJ <br /> rekn4dtC�ttw\� wD, plaLVl . <br /> SITE STATUS 5T n l avut i io WW IQn rnevt wt tv. cA..4-1 <br /> l)AR ✓c120w+ Cwtd added -ty,) -nn. eovt Stk- �xtbe. <br /> _ T:DrFhev- tn.uz�r5t-t FYNa yzatacL wi i-itil f24 1esuty---d b <br /> _ Pt-{5/El-w o-vicL f o - 71-e G 111Zn1l�CR <br /> EH 22 013 (Rev.4/91) <br />