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+ _ <br /> SAN JOAQUIN COUNTY �. _ <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHAR , J ' <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:6 II III PHS-EH LOG# Q( OS I <br /> (Circle one) <br /> B. SOURCE OF INFORMATION <br /> Name:_. sbk,, Sn '/p4SSe✓L Phone: Vac ) 2.39 <br /> Company: Cdu o� Ykn Qe <br /> Address: <br /> Designated Employee Name: Phone: <br /> Reporting AgencvName: fow Sta+w1. Q E(n,e} Q 'w v� <br /> Address: 3OL( f. IjQg g <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: q( gI '. OU'A / <br /> (Ci r <br /> (Best Physical Description) County) Circle one <br /> Date of Discharge: (U` / (to (01 <br /> Date Notified- t Time: I'- <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business:_ DA e-4A P.,1 ro(e J W` <br /> Contact Person: Phone: 39-79 7 <br /> Phvsical Address. l9 S . & S{(e�1 MAV+Ca <br /> Mailing Address o. 6 � 71,�l � M.e� GN <br /> E DESCRIPTION <br /> Type of Discharge: (JIn 64)Y/-e r <br /> Volume: UwGµ� V� <br /> Chemicals: C�c rOU Q. <br /> Circumstances (1cv.. Leda a.d CvQ¢.o.,1 o�ac <br /> Lu#o 0. 5dyr a,�n <br /> F. ACTION TAKEN /v��l�pr;c. lJ.LQ� Wasd9- <br /> © ;L GtJ4 s rn1 <br /> SITE DISPOSITAION S ait IJd � S CQ� vQ <br /> r�.`m iC� ,_!�� A 3 L1l�InU 621 <br /> lam' (l �.lra,Asaor <br /> EH 22 013 (Rev. 08/20/98) <br />