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• SAN JOAQULN COUNTY • ��� (C`l JJIFY <br /> NOTD-IC�TIOYOFH.aZ�RDOliSWASTE v `/ <br /> HEAS.TH 3c SA =IY CODE '_I30.? <br /> A. II III Pic-a! LOCI- OCO"©UU <br /> (C'ucia one) <br /> g. S O(jRCE OF L(FOR_NLL-7ON <br /> Name: At e,-le /�� cL� < s r Phone: Na) 73s -/Say <br /> Comnanv: (r ie ti <br /> Address: s>s /) c/ /fie f/�! S £ Se.H y yam% <br /> DesignareC E=DIovC`lame: <br /> ?hone: 10 9- Y .3yya <br /> Rdocrang A_rcy Name: /Z rro <br /> Address. �7E-. GJe 66 Er ,4L� e <br /> C. LOC_>,lOY ALN4D DATE OF D[SCciARCE <br /> Location: /0,F-/ t.2, <br /> (Bea P!n iei Desc.noaoa) City County) Cucie one <br /> Dace or Disci cge: C/�ICAywr <br /> Dare ;to¢aed: ( -/6 o-t3Tome: a <br /> D. RESPONSTBLE 02ON/BCSurcSS <br /> Hanle at 3usiness: vz t tler5/ 0,c <br /> Coar_ec P-^zoa J e Phoae: <br /> Ph sici Address: ol <br /> (a a/ <br /> . -ding .id&=m: 3(90/ �acr <br /> E. DESCR TON <br /> T«e of Discr3e: G�� a oaf ti ! zeo0 <br /> V 0lllme: n/lit �J <br /> Caeaucis: T6 <br /> C;reams,:aczs: St_ / sa 7 /r i e s k <br /> F. ACTION T��I f S T <br /> SITE DIS?OSMON <br /> CC SL <br /> ( Ts <br /> =' 3' U U (Rry 03%-0/93) <br /> CO <br />