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SAN JOAQUIPI COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL( % II III PHS-EH LOG# D DoZ� <br /> '(Circle one) <br /> B. SOURCE OF INFORMATION <br /> Name: t-4- 2c ( � Pho e: (W SSS—31 15 <br /> Company: a t°na( (t)a err14( n d 8 d <br /> Address: c(tk eq- °0 (m Phone: / 1SS-3//—S' <br /> Designated Employee Name: MF-r r <br /> Reporting Agency Name: ( a O.-Aa (.,4-m C&4r o 1 L56 SCI <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location loe-C&PLUS �- <br /> (Best Physical Description) (CVo­ oun Circle one <br /> Date of Discharge: ckn LAbw <br /> Time: <br /> Date Notified: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: S 0 Lt ✓'G <br /> Contact Person: <br /> Phone: <br /> Phvsical Address: <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: n�"U) <br /> Volume: ll✓� �n <br /> Chemicals: D C-A <br /> °Cs <br /> Circumstances e n� Ulp ll cD u 5 �� a f 1 C�[Q_ <br /> e l e �4 ov, —13 <br /> F. ACTION TAKEN t e r rkred 1 . <br /> n�l ( 04 o I� <br /> SITE DISPOSITION � IC c� e-Ja <br /> a tm a a n� una �rz <br /> n <br /> ►a.n ks e (oe�r �n ( t e s� S t� JAILS <br /> Ide.[� rTt�e.! <br /> rem( -1'D t Ong-( oa rte( -�r c�'t Din. <br /> EH 22 013 (Rev. 08/20/98) <br />