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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE r, <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: 011 III PHS-EH LOG # CH <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name; (ettcceto Phone: ozo <br /> Company: �IV56 L�dS (l u� a�rne <br /> Address: O. go CaZ MD 2- <br /> Designated Employee Name: Phone: Lj <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE �� <br /> Location: Z7 �/ <br /> (Best Physical Description) Ci or County) Circle One <br /> Date of Discharge: ce-IVR <br /> Date Notified: 8 /- -9/ Time: ✓ffgm <br /> D. RESPONSIBLE PERSON/BUSI SS <br /> Name of Business: Uteo .�to��ce�i �o• <br /> Contact Person: • C _ Telephone: <br /> Physical Address: <br /> _4000 Q Qa m cda �5A o <br /> Mailing Address: R0 6eX Ste// _ <$ .9M-1— <br /> E. <br /> OZE. DESCRIPTION <br /> Type of Discharge: <br /> Volume: <br /> Chemicals: <br /> Circumstances: <br /> F. ACTION TAKEN /�• L/�Ot /cam Plj �u�»uec� '� l�Ct -�' `�'L <br /> SITE DISPOSITION S/ lJ <br /> _. <br /> t G O <br /> EH 22 013 (Rev.4/91) <br />