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SAN JOAQUIN COUNTY <br /> NOTIFIU ON OF HAZARDOUS WASTE DL., GE <br /> HEALTH & SAFETY CODE 25180. 7 <br /> A. EMERGENCY LEVELOII III PHS-EH LOG # <br /> (Circle One) <br /> Be SOURCE OF INFORMATION <br /> Name: re:�n/ o 0� Phone: <br /> Company: <br /> Address: - <br /> Designated Employee Name :_ Phone: ( �? ) Y6J' -3Y6 cf� <br /> Reporting Agency Name: vaoU ' o h �� S <br /> Address * yes' /> So – e <br /> Co LOCATION AND DATE OF DISCHARQE <br /> Location: l c� ;:j A-*"- C4 /zz� A/ u ~ <:z <br /> (Best Physical Description) ty County) Circle One <br /> Date of Discharge: <br /> Date Notified : � –6 - 9i Time: <br /> D . RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: r/wc�tV shqob <br /> Contact Person: ice-- s S «wo f5 Telephone: (,�) 9YY -5-6 -77 <br /> Physical Address : /ion .5% ssi cts- 6 L� ��- <br /> Mailing Address : <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume : <br /> Chemicals: Xce lelEe r/f// -G <br /> Circumstances:— .lTTcm r a� r//� !r, 7 ;/ c 7C s�s <br /> F. ACTION TAKEN <br /> SITE DISPOSITION <br /> s-. cr/� oceL LP <br /> owl <br /> EH 22 013 (Rev.4/91 ) <br />