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SAN JOAQUIN COUNTY <br /> NOTIFIC.'kTION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> EMERGENCY LEVEL: I III PHS-EH LOG # <br /> (01rcleOne) <br /> 3. SOURCE OF INFORMATION <br /> Name: K,,G\1 <br /> Company: U � �C--L � G r s Phone: 3a a _Z.1 S ss> <br /> Address c <br /> Designated Employee Name: Phone: E `/b k-0 3a y <br /> Reporting Agency Name: San -"s 0,0; U> Cd - c \ ✓� <br /> Address: `t LI 5 A) . S�n a \j , <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location:_ 5; y {-I^ <br /> (Best Physical Description) r County) Circle One <br /> Date of Discharge: (��/Ci7oa/ A <br /> Date Notified: 9aTime: 3 =���o"r, <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: r,, 0CA\n <br /> Contact Person: 2.�k r n4i Telephone: <br /> Physical Address: <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: rA-v <br /> Volume <br /> Chemicals: 17,�s�1 > >oP��rnc \ucnt <br /> Circumstances. � cnz_c�c �_�ylcnL <br /> ��o\�K� ��c �c m on Ml,ic +4n© , <br /> F. ACTION TAKEN C,1 <br /> eS <br /> 7-�4I mn t �c <br /> o L C L <br /> bG5 1G4 E{ 17 4t.P/ / <br /> SITE DISPOSITION_ G..thci /v,r es �,toc o.J / rss.v <br /> �i zynw4 <br /> EH 22 013 (Rev.4/91) <br />