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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG # / Cl - < `� <br /> cle One) <br /> B. SOURCE OF INFORMAL ION <br /> Name: kriL jarPhone: (g� 6-1701 <br /> Companyy-Ip w' <br /> Address: 2)0`71 P,-12 Or o. SQ r ('r4 'SS K;17 <br /> Designated Employee Name: Phone: <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE O DISCHARGE <br /> Location: 115 -- av)LC bi (-L CI Y-(, W(A4\4--e-aL _ <br /> (Best Physical Description) tty ' r County) Circle One <br /> Date of Discharge: <br /> Date Notified: PV,2uS+ W- R3 Time: .Oda. a . <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: CA,( I kJ + Lrcre;' -- L-4, r o, <br /> Contact Person: FS( Lt jO h Telephone: ZU 5a3 -� <br /> Physical Address.• 1t53 q4 b`bi L(-&(z r vt-I-eL,9, C, `153 <br /> Mailing Address: <br /> E. DESCRIPTION fir✓ <br /> Type of Discharge: i a 1a] 3-� n - `S i Vim) (2 Fn F� 4fL� <br /> volume: <br /> Chemicals: <br /> circumstances: 1 f U vu r��1T `rc rn� al4o� v�lc (t ui G11� 7 (✓� - l��Lr�c�� <br /> (1 9 l <br /> F. ACTION TAKEN - 0V\L (-i✓CINQ l �Xej C�i5 &LQg4�G L <br /> SITE STATUS Cc IV cJ St 6M'a � 46 -f-CVh rh 2_ <br /> l , n U k <br /> -k TKS vlo-4wrn ,s �i rXr� ilovo Atv, 4Cavi mvyc kt ,9s <br /> EH 22 013 (Rev.4/91) ntr Gti -f ,1,\� <br />