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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:6 II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFOELMAT ON <br /> Name: Phone: Z-? f I <br /> Company: CO <br /> Address: Zocr, ,,,) c yo o <br /> 17141 <br /> Designated Employee Name: Phone: (_) <br /> Reporting Agency Name: <br /> Address: <br /> �. LOCATION AND DATE OF DISCHARGE <br /> Location: R4 OC, 71" oma-- F�-k <br /> (Best Physical Description) C-1�3 or County) Circle One <br /> Date of Discharge; 1w� <br /> Date Notified: Time:-4!00P-,U <br /> D. <br /> imes !00P- UD. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: T Sc� 1Mcv� t Co <br /> Contact Person: Telephone: <br /> Physical Address: <br /> Mailing Address: 200 o CAw, <br /> E. DESCRIPTION <br /> Type of Discharge: L AJQ- <br /> Volume: LvJ — <br /> Che_micals: <br /> Circumstances: <br /> I <br /> ACTION T.4J<EN <br /> tZ, rI q$ <br /> w <br /> c U <br /> SITE STATUS <br /> `7H 22 013 (Rev-4/91) <br />