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SAN JOAQUIN COUNTY <br />NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br />HEALTH & SAFETY CODE 25180.7 C(� <br />O F <br />A. EMERGENCY LEVEL:1 II III PHS -EH LOG # <br />( cle One) <br />B. SOURCE OF INFORMATION <br />Name: Phone: (_) <br />Company: <br />Address: <br />Designated Employee Name: Phone: (_) <br />Reporting Agency Name: ZqLn4 V c) <W, (Zo a� 4 6 2,- 391 9 <br />Address: a -a C . we,Z.e r t+v-e, 12-vr► �k &(o SSD mak-# ave GI9- a <br />C. LOCATION AND DATE OF DISCHARGE <br />Location: (2G+I ; Mac bbnaJ =sk kLd -- Tur ft,�r Gu f - / S - <br />(Best Physical D scrition (City or ounty) a One <br />Date of Discharge: l tTC1 <br />Date Notified: 5 1 ( IA4,Time:—//.' 506k -/ -1 . <br />D. RESPONSIBLE PERSON/BUSINESS <br />Name of Business: PG -I- r✓ - Ce) -fir a� A-& p pxey`-h-� . <br />Contact Person: E74 wo r.- M ooze. Telephone: <br />Physical Address: 3-1 S Q4 Lit ut e_ (,tea 1 In Gu- Cr e%ej1— <br />Mailing Address: (saw) <br />E. <br />F. <br />DESCRIPTION <br />Type of Discharge: <br />Volume: <br />Chemical <br />Circumn <br />=8,-W4 40 r t l u '(Y Y L)t be- \ <br />ACTION TAKEN -Tne- p 1 L,061(ne-A W4\ lopoo)5—oLvLA aJoS o✓ b 06t. <br />SITE DISPOSITION <br />EH 22 013 (Rev.4/91) <br />