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SAN JOAQUIN COUNTY <br />NOTIFICATION OF HAZARDOUS WASTE DISI'KARGE <br />HEALTH & SAFETY CODE 25180.7 <br />C'��� <br />A. EMERGENCY LEVEL: 35 II III PI S -EH LOG #_ <br />(Circle One) <br />B. SOURCE OF INFORMATION <br />Company: " <br />Designated Employee <br />Reporting Ageng Na <br />Address: a*moi 'V, <br />Phone: (�) <br />Phone: <br />C. LOCATION AND DATE OF DISCHARGE <br />Location: 'y / / b7 Al <br />(Best Physical Description) (City or Com) Circle One <br />Date of Discharge:/V r -No 4oAt <br />Date Notified: 7 2 a Time: q aoe a w� <br />D. RESPONSIBLE PERSON/BUSINESS <br />Name of Business: -'j -r,4- <br />Contact Person: Telephone: (� <br />Physical Address: /2 zG7 <br />Mailing Address:l2-a L7 E- <br />E- <br />E. DESCRIPTION <br />Type of Discharge: ✓fie.Q& a-44 <br />Volume: <br />Chemicals: _ -j5AD Q <br />/%f/£6,Nz1r-0- 4o -^JD 5WA4CE -7AN K Rfi4p L ��OILykTit'S n��or,tTidt�2N�7-ioh(_ <br />ACTION TAKEN -F,4-Ne- zyil-s RE�ro�El� <br />SITE DISPOSITION l/ t/c7t'iL6Qov+1l� s� n L�4 r� NI< <�c,Sn/�¢rion/ +.•moi <br />/3e- ao�v�,En/rEp wT !ii$e� s2�voa� t �BN� v4aDE�] ?v �o�F7aiuT V T£� <br />5 (7F— <br />/3E iP�o�i�<%^ r3Y Ef/ �4-NDfo,e G1/•Qc✓QGf3 <br />EH 22 013 (Rev.4/91) <br />