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r <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I I III P-VHS-EH LOG # <br /> cle One) <br /> B. SOURCE QFINFORMATION <br /> Name: r- r Phone: <br /> Company: ��' l_�_jz,yfl <br /> Address: l K k4 r� I SS > <br /> Designated Employee Name: Phone: �) <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATIONANDDATE OF DISCHARGE <br /> Location: C'D <br /> (Best Physical Description) (City o ,County) Circle One <br /> Date of Discharge: v -�-, <br /> Date Notified: - ;2--w-—k-5- Time: <br /> D. RESPONSIBLE PERSON BUSINESS <br /> Name of Business: r^ <br /> Contact Person: V1 ,-f- Telephone: Lza 5� Z777�4 <br /> Physical Address: 5 S w `f'fit Vit- . ✓ - -� <br /> Mailing Address: pInyj �- C� --3 3� <br /> E. DESCRIPTION <br /> Type of Discharge: ul'l\ <br /> Volume: �-1 v n <br /> Chemicals: CC SD I i✓l e, <br /> Circumstances: e-JtCc� I --Le, U - ✓U OS aV1 S fic <br /> �e- I n r f <br /> F. ACTION TAKEN <br /> [—QA(t, 6�Oj I?I Dt 0 V)AdJC- r 'S <br /> SITE DISPOSITION S T vv h rSi <br /> f L I e-A 1& <br /> EH 22 013 (Rev.4/91) JY\0\-aC� PLii D�t Clv,,d \X�rl'CLk dna <br /> Ukr\L 5C� <br />