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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: UX III PHS-EH LOG # 7 �4 ' [_.62 F <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Phone: (_) <br /> Company: <br /> Address: <br /> Designated Employee Name: Phone: (_) <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 4(o1:'--+ bQy1Y1G1 b��Je- / ���-k- ►rl <br /> (Best Physical Description) toor County) Circle One <br /> Date of Discharge: UVnl4'tio\-O n <br /> Date Notified: a-21•-q-+ Time: 1:3 P <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: Swt tct,vlcl <br /> Contact Person: 'Bob 1Dt.Ntnao Telephone: (Zoe) 251- `t l55 <br /> Physical Address: (,q o 33 W10-5 i U4Ue!�j t h!gh�7 1 -- 10q lokat W/k 4'f03 Z <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: Pef-r0te.0w1 h(jv'oc�rb0r1,5 <br /> Volume: V iny n0v-3 n <br /> Chemicals: &C-soI tv-w, LC>Vj5h f u4.nt-5 <br /> Circumstances: DOW j SOLI 0,.vh GDA+d.rnjMtj&,q I ►') <br /> JSta.rn,ot�5 t_ott�c�K� d.t�ru�, a Qy'2- -14.n1� Iln.tt� ct,55t�5�r� <br /> F. ACTION TAKEN -fhc V�tLt.ut no r mej V,%-e 1. cLG e— tow 6.0- Goin-AE=eJ <br /> W tin I6L(00rG,tv!—r . c+-P-al�fscs of -gy s4w�pcas �o t <br /> SITE STATUS eDLk, LOU W f D 41 ove-y sL � <br /> N cw.d rh addity� lf'1Ve5 <br /> o� h v t- t -e LtK <br /> de 7' v( LorLegg <br /> EH 22 013 (Rev-4/91) <br />