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r—j C JOAQUIN <br /> SAN <br /> COUNTY <br /> NOTIFICA"fttN OF HAZARDOUS WASTE DISC4,.- GE <br /> HEALTH & SAFETY CODE 25180.7 <br /> CC(0 yi -[l H 7C)3 <br /> LOG # <br /> A. EMERGENCY LEVEL:C!). <br /> (Ci"xcle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Phone: 6ZA--%!jL <br /> 'T <br /> Company: Son-Lco <br /> Address: kf3 I NN. qa-a'a eo& <br /> Designated Employee Name: Phone: <br /> Reporting Agency Name: <br /> Address: <br /> 06 <br /> C. LOCATION AND DATE OF PISCHARGE <br /> Location:• 1-4. 52=4m <br /> (Best Physical Description) (City or"u� Circle One <br /> Date of Discharge: <br /> Date Notified: 10 Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: <br /> Contact Person:- Tele"P hone: <br /> Physical Address: On 1,S V-h �j <br /> Mailing Address: IGAM"r Ik <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume:, <br /> jI II <br /> Chernicals: JL57- <br /> Circumstances: LvlrmuLb� Dzkwd'o� <br /> eg-YA"ewa1t02'�L Lad2gar1�1 4199S wil X-6 <br /> F ACTION TAKEN <br /> ncvrm� AWC 90*.1- 9�w� em=dUm= AKC <br /> I 4&A pAAt&paLtggr. M43C <br /> SITE DISPO91TION 's'� Avas ams-1 .aA16 0�m q-ar "6'4k <br /> 0, 1,15AL- yvLd;krL -T b"' cJ6t- =�gAJAAMI:-- <br /> 16 <br /> EH 22 413 (Rev.4/91) <br />