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SAN JOAQUIN COUNTY D <br /> NOTIFIC-,-,'ION OF HAZARDOUS WASTE DIS--IAR • <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II III PIIS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION I <br /> Name: F, t o .x�- �c s erin"C Phone: (zc ) 9,7 6 <br /> Company: l,r.)les <br /> Address: S-3 <br /> Designated Employee Name: Phone: (z&2 ) V 76-J 6 3S <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE QF DISCHARGE <br /> Location: O ` S W me v;s �- / �-•c`/ <br /> (Best Physical Descnption) (City or County) Circle One <br /> Date of Discharge: v1�7/c/7ot✓� <br /> Date Notified: 'r- 11- 9 Time: S U 0 �o,-1 <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: — <br /> I <br /> Contact Person: /)C' F•-,1 ,-m45 Telephone: (zos)_�_3s- 1 z3 <br /> Physical Address: S-- C,). t;�„� o ,—��Y� 614 <br /> Mailing Address: s e 4f- <br /> E. <br /> E. DESCRIPTION n r <br /> Type of Discharge: ��� c�.4c ow <br /> Volume: V17�ho✓n <br /> Chemicals: eA {C&I <br /> Circumstances: CA r, �c 'nG , o 4Lic, <br /> / q 7Ql7/'26,"L74 &,r /I ST, /4 0/1 <br /> F. ACTION TAKEN -TT-,e- 5�� ves v s `4d� 4 7 <br /> A 7te 1)(!)'-j L 'DAr,- r0-T L—� It5 <br /> / o �nG <br /> n 7�cG a✓ <br /> ,4A <br /> Q 7L <br /> 7A e <br /> C/ <br /> SITE DISPOSITION <br /> lf/a1z'i via ` o o � r" <br /> }C ' / <br /> EH 22 013 (Rev.4/91) <br />