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r <br /> SAN JOAQUIN COUNTY <br /> NOTIFIC7MON OF HAZARDOUS WASTE DI GE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:© II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: v Phone: (f 3 -l7c-)L <br /> Company: K1c1h Nuc <br /> Address: 7,3-i-7 1-1t c (' !r c l r <br /> Designated Employee Name: Phone: (�) <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISC�GE <br /> Location: 1 at 0 5 f3rO4 C1/4'1S✓ <br /> (Best Physical Description) (City or County) Circle One <br /> Date of Discharge: vn, eoc,/M <br /> Date Notified: 3— 4/ Time: 3:(904•-y <br /> D. RESPONSIBLE PERSON/BUSINESS I ` <br /> Name of Business: rt a n n, 1 y i ct S <br /> Contact Person: 4vv, ar Telephone: (U+') 1166- 55 11 <br /> Physical Address: i5 o S &,near u. Aj . shoo— 9S zc-�/ <br /> Mailing Address: Pv box 2010 9 <br /> E. DESCRIPTION a Icovj JA�✓ <br /> Type of Discharge:�;� r.�v �c n� rc t1o+� ..jrs oQe ,,ia ��vtt s <br /> Volume: vh Awe /I <br /> Chemicals: 1 Z- nj, 1,1 <br /> Circumstances: L�.Cwt;cn is k. n re u bully k,o rh ` <br /> F. ACTION TAKEN 4 �,/LS c�r�f <br /> 7b ✓ <br /> a%CSS lie e-y-leo <br /> SITE ISP SITION G 4 -o/ �o + Or / va 1 <br /> Tr'c� a rcl S. L, ,' 'd A a <br /> Al Z�azw <br /> EH 22 013 (Rev.4/91) <br />