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r <br /> SAN JOAQUIN COUNTY • <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 COPY <br /> A. EMERGENCY LEVEL: II III PHS-EH LOG # 93-679 <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: .5'�A24� t n ✓tett s(..� iI)AC QL rc6j /roc. Ci b , Phone: Seo ),;L q - !5�J— <br /> Company: sU,..o u s 44OL".0 <br /> Address: e lorAnl/ Y /"3riy-e 5wap /(Y � OL�utFw+iy Cts 4YSS3 <br /> Designated Employee Name: (-,,co( C Phone: (20J Y(c Y- 3 4 `(O <br /> Reporting Agency Name: S _:6 C� <br /> Address: w5- ..J. Si;., JVGt/�,.�i:� : Gq <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 157v f. �/-Jv-em <br /> (Best Physical Description) (City r County) Circle One <br /> Date of Discharge: �w <br /> Date Notified: a f3 Time: /®AM <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: u / L4,J 20 6or6/4 /--5, 4tG- <br /> Contact Person: 7) , ,. 1e d� g 4 s Telephone: (,A�f) Y6 6 - o 7� <br /> Physical Address: Is-'Iv F, S�C/c.Lvn s ZA) <br /> Mailing Address: s� <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: cz"7 <br /> Chemicals: Ga so/,,IoviP�/ / <br /> Circumstances: /Qs �i�M �c.sE lP�d✓� ,k(�icu/2 CU /u nCKc� « <br /> F. ACTION TAKEN <br /> SITE//DISPOSITION /Gw s;4r 4r49ief7A�,T ,,. -12.e G�/ o <br /> N/+L(,w f ec <br /> t � <br /> Pc. .e� ✓ 45 r(/N <br /> EH 22 013 (Rev.4/91) <br />