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., - G✓t��e-viva.-f' <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE C(Dpr <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG # / D <br /> ( ircle One) <br /> B. SOURCE OF INFORMATION <br /> Name: F. 8f'1�no n't Phone: C�4) ��Lo-51�09 <br /> Company: AK01b ProdAto,Is 0o <br /> Address: P o Box (,00 3f3 Ar'4-e5t'&, CA 90-0Z -6036 <br /> Designated Employee Name: Phone: L� <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARG �l <br /> Location: 29 D8 �� uc <br /> (Best Physical Description) City r County) Circle One <br /> Date of Discharge: LI-1 b-9 q <br /> Date Notified: 6-13 -0 Time: /D:�•rn„ <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: 4� 213 3 <br /> -` Contact Person: e-ier u.�0 w Telephone: Zo9 47 - 5755Z- <br /> Contact <br /> `�✓ Physical Address: 0500 W i 1D-r Sir K62-1) <br /> Mailing Address: P D a G Ar{�t'� C+ 4/09-0 2 -60.:36 <br /> E. DESCRIPTION <br /> Type of Discharge: riv',e, <br /> Volume: 2 a <br /> Chemicals: 6 a 501 i <br /> Circumstances <br /> F. ACTION TAKEN <br /> SITE STATUS 146 �d 'l <br /> 7�) /(� o <br /> L <br /> EH 22 013 (Rev.4/91) <br />