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R <br /> .. SAN 30AQUIN COUNTY TANK <br /> NO�r'iCATION OF HAZARDOUS WASI'E'ttCy.,ARGE <br /> HEALTlri & SAFETY CODE 25180.7 <br /> A. EMERGF.NCY LEVE._..: Q II III PHS-EH LOG # I J v -I O <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: `�ticSnar� wo.+Ovl Phone: Oj! 37Z-(888 <br /> Company: W l-E- <br /> Address: Fr)34 �� : r�rtcu.-b �}Slaq <br /> Designated Employee Name: JERRY YOSHIOKA phone• Z�O9 468-0335 <br /> Reporting Agency Name: SAN JOAQUIN COUNTY ENV IROMMMAL HEALTH <br /> Address: 304 E. WEBER AVE. <br /> C. LOCATION AND DATE OF DIS GE <br /> Location: 'AOS (2a(Iornrn, .. <br /> �� <br /> (Best Physical Desciotion) Ci or Counry) Circle One <br /> Dare of Discharge: l�h kn cw►n _ <br /> Dare Nodfied: IS4 Q 1 qQ:� 'j"tmP• t ICU <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: Em't 'S Lsodur (and <br /> Contact Pe=on:-- t c� Telephone: 83d- ":�loeS <br /> Physical Address: 1405 Caldcrn;ea. - <br /> Mailing Address: sc�rnc <br /> E. DESCRIPTION <br /> Type of Discharge: �asc_ �� . <br /> Volume: <br /> Clrcunstances: of 1 c,� -C4- <br /> I'lu m <br /> p ACTION TAIMN 3oc.( ,-4mc�a 4-¢<cr-� r- nna� s,►s _ �xCavGt-�-CC <br /> L l <br /> SITE DISPOSITION t h <br /> nCrr• Sl ( � mi ` <br /> r 1 <br /> EH 22 013 (Rev.4/91) <br />