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f • 1 <br /> • SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> r <br /> Cc- <br /> A. EMERGENCY LEVEL:0II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> O Phone: (3D9) 9Y6 —o a- <br /> Name. �r <br /> c <br /> Company: „ Tou <br /> P Y� <br /> Address: o £• C, C4 <br /> Designated Employee Name: o Oel' OZ Phone: So9 YCoP avY� <br /> Reporting Agency Name: u a as, u o"e <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE '?Ole t- D <br /> Location: a s� Ci r County) Circle One <br /> (Best Physical D cription) <br /> Date of Discharge: 0 R —0-7 —S'S <br /> Time: <br /> Date Notified: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: o 1- Telephone: (22f) <br /> Contact Person: i%r Go v c 14c,, <br /> Physical Address: <br /> Mailing Address: n s <br /> E. DESCRIPTION <br /> Type of Discharge: � u u <br /> f<vvr.r Ltd ✓2 �C4 i.7 CZ <br /> Volume: <br /> Chemicals: <br /> Circumstances: �u �k i e� ✓�9 <br /> F. <br /> ACTION TAKEN <br /> —ILI f � n L <br /> O� Cv -AG c P rsna v <br /> c P <br /> Te /7 ".57 <br /> SITE STATUS C+ v -A� <br /> EH 22 013 (Rev.4/91) <br />