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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 # _ <br /> (Circle One) <br /> B. SOURCE OF I FORMATI N <br /> Name: e \/e, A-rl d LO rnJ Phone: P�� <br /> Company: E5 lZf-- - <br /> Address: '-. '6' ( S <br /> Designated Employe Name: "lam e Phone: <br /> Reporting Agency Name: S ^1 oA9-1-t o n/ �« rk/ ! <br /> Address: P n t3 o->< 'L002 _ c?o c 7W, . CiiPcC , J;-7 -6 <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 3-7 7 S- \/ � 7R 1+ c 13 LVO / / �y9-cI� 376 <br /> (Best Physical Description) (City or Co ) Circle One <br /> Date of Discharge: q,— I r, — --j 3 <br /> Date Notified: Time: '3' 1 -7 A-" <br /> D. RESPONSIBLE PERSON/BUSINESS ��ff <br /> Name of Business: 6 (—�� 0A e, V Ie0 1� <br /> Contact Person: N Telephone: C.-240 k3 6 —Z/ a 1 <br /> Physical Address: �— V Gv'N-- <br /> Mailing Address: cT. .cam o <br /> E. DESCRIPTION <br /> Type of Discharge: (- <br /> Volume: I <br /> Chemicals o <br /> Circumstances: D g + Ve ve. <br /> +4L f) OU l4 { 14 sj 2 Inns e . <br /> F. ACTION TAKEN -M44rcA�i 4-7 <br /> a. �s <br /> fS S a 2 <br /> L V <br /> SITE DISPOSITION SS�55 <br /> EH 22 013 (Rev-4/91) <br />