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SAN JOAQUIN UUun z <br /> NOTIFICA,,,j.)N OF lIA'LARDOUS WASTE r CI-'ARGE <br /> 1-1L:ALTI1 & SAFETY CODE 25180.. <br /> �:,"PHS-EI-i LOG # <br /> A. EMERGENCY LEVEL: T�. '' II IlI <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: `- <br /> T�le hone: <br /> ���� ��' p <br /> Reporting Agency Name. <br /> Agency Contact: FgtZ- Telephone: C2,ot <br /> Address: W t(5. IV- 5M' --0A rvU/t <br /> C. LOCATION AND DATE OF DISCIIARGE <br /> Location: l�(' Z c <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: <br /> Date Notified: 1;1-?.6 -,q�j Time: <br /> D. RESPONSMLE PERSON/BUSINESS <br /> ' QGc,�LS� ,(_tAirtrnfGnv r', 'T_T.az <br /> Name of Business l ,5" L ' "� "`' _ <br /> Telephone: <br /> Contact Person: �r t4l BEY ooPE <br /> Physical Address: <br /> E. DESMON <br /> ' Type Release: <br /> Volume. <br /> Chemicals: 0-r Y& Z,F�� X� n N� -r-PP C g01�"�r <br /> F. ACTION TAKEN S o i L 2 FSuan/,4-C__ /,✓d ic.¢i c <br /> �►.r-�iN•a-n ✓ <br /> �z 14--1 -7D Oi-� rl IJ F <br /> Tl�� �i� D c�n1T/ -t�N•�?I -` i2��'c%r i 7 `r' N F <br /> Eli 22 013 (Rev. 02/90) <br />