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� SAN JOAQUIN COUNTY <br /> NOTIFiL-trfON OF HAZARDOUS .WASTE DiaCO aGE <br /> HEALTH & SAFETYCODE 25180.7 <br /> � II <br /> r i_1 <br /> 1 F <br /> J <br /> A. EMERGENCY LEVELOI III PHS-EH LOG #_ <br /> (Circle One) I <br />{ B. SOURCE OF INFORMATION J!J/ <br /> v 3 <br /> Name: � ccr�Ps �. 0 � ! kk ' Phone: e� �i '-3 O <br /> Company: S44�S -5-u <br /> Address: 470. �� ��oo� aack-L, t,2 <br /> 1 Designated Employee Name: Phone: (Z� /S -SUvD <br /> Reporting Agency Name: <br /> Address: p. C3z oz✓9 S-7`�r, ,v r�1 9s' ��> - <br /> ! <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: /"s'3 z % <br /> (Best Physical Description) r, (City or County) Circle One <br /> Date of Discharge: ti/Nd �✓ p ! <br /> Date Notified: Io/' -If Time`: <br /> D. RESPONSIBLE PERSON/BUSINESS _ { <br /> Name of Business: <br /> Contact Person: }'Telephone: /� �iod3 <br /> Physical Address: 3 I� os r- ; a 9562 <br /> Mailing Address: Gs Ai� f�� Ll�/n/rr�ss t? j. <br /> I E. DESCRIPTION- <br /> Type <br /> ESCRIPTION '! <br /> Volume:of Discharge: U,1,Z <br /> i Y olume: <br /> Chemicals: <br /> Circumstances: G•, rocs Szr> I`Psra/ rPtr;�Pe i /,,,,•e <br /> F. ACTION TAKEN_ 61.41Z Y,5 5— <br /> i <br /> 5 SITE DISPOSITION U JY <br /> _ Ca t:� a' ti.ti^ lct � NCt!/rtt�c d7s• I n / <br /> f . <br /> i411 <br /> EH 22 013 (Rev.4/91) <br /> j j <br />