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SAN JOAQUIN COUNTY <br /> f NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> 1 E <br /> t A. EMERGENCY LEVEL: II III PHS-11T LOG <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: uce- C < X55 Phofi: L; X35�}a72 <br /> Company: 'ss rZ a v <br /> Address: h/ d GA- 95 76 <br />+ Designated Employee Name: /N,` l Phone: TWO � -3 <br /> Reporting Agency Name: 6ef_ G <br /> Address: D Rv�t ��a 9 ST�lcfar✓ 9s^Za/ <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: %5" AA54 111�. L4-n/12 Ale, <br /> h (Best Physical Description) (City or County) Circle One <br /> Date of Discharge: _ U/Ksiao✓r/ <br /> Date Notified: 'j - 3B^G ! Time: cY !ov ±zi <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: -/55 M ne�L,a✓ �1 <br /> Contact Person: o,Ce, iL1.55 Telephone: C <br /> Physical Address: - Wn/,!� ei / — <br /> Mailing Address: Sa.�e <br /> E. DESCRIPTION ��� <br /> Type of Discharge: <br /> Volume: U A k1ti,LvrJ <br /> Chemicals: o CA r-1'.2 u,�l <br /> Circumstances: wae, v v ' S <br /> S 4�(/lit/ (.0 nl T.d M A� 1'x'2 l U`F• <br /> F. ACTION�/TyAKEN__ / R /Sob /�, a-�lI(/C'// 9C�a/r h.e^. } ,d��jJ� Wim <br /> I <br /> II <br /> SITE DISPOSITION jAjILL <br /> V-p <br /> C!7 010- ^LrC (,( I ft <br /> r i <br /> EH 22 013 (Rev.4/91) <br /> f <br /> i <br />