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F V <br /> .. -Vol <br /> SAN JOAQUIN COUNTY COPY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGEHEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL6I I III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: -A vi C. Phone: 510 775 -/G Za <br /> Company: <br /> Address: P 4 kcro �- 4 YS S 3 <br /> Designated Employee Name: \c G a/ H;h Phone: (zc)y6,v-os3q <br /> Reporting Agency Name: S4r o tf S-Ek+ <br /> Address: �14I� kA� <5 9s r o <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: z - / S�C <br /> C�n <br /> (Best Physical Description) Ciry r County) Circle One <br /> Date of Discharge: - �2-r-4 3 <br /> Date Notified: It -4'S Time: I0'.00 Q . <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: A mfr" c r N cul J l c a o j L` l lk-� o r 1- <br /> Contact Person: (;C-0 ri C Who n k i!� 0 Telephone: Zai) 9 4 6-STSs <br /> Physical Address: Z cQ s- <br /> Mailing Address: Po Bon �3 it' <br /> E. DESCRIPTION �ll n <br /> Type of Discharge: V Y,\c,v�` c V+%z-t4i e <br /> Volume: o <br /> Chemicals: <br /> Circumstances: Ilk <br /> cr vtou� I n - <br /> F. ACTION TAKEN <br /> r v L rbc+ <br /> 'rte W ! 4 n ` �K. ✓l�. d � _ <br /> N 1C <br /> SITE STATUS <br /> ��/ rt wlPrY` 4 fr��l <br /> EH 22 013 (Rev.4/91) <br />