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I _ <br /> G � a <br /> M SAN JOAQUIN COUNTY C ' <br /> NOTIFICATION OF HAZARDOUS WASTE DISC COPY <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL : I II III PHS-EH LOG 4F_ <br />.� (Circle one) <br /> B . SOURCE OF INFORMATION �-{�'' II <br /> Name : Q� Phone : 4A � ()gq� <br /> Company LO 40irO✓IW1 VIf� Q <br /> Address: UJ C � �30S <br /> Designated Employee Name: D Phone: <br /> Reporting Agency Name : <br /> Address: <br /> C . LOCATION AND DATE OF DISCHARGE <br /> Location: IqO I S. EI POKa6k) <br /> (Best Physical Description) City r County) Circle one <br /> Date of Discharge: Un ILVIOw V\ <br /> Date Notified: Time: 4 : DO � M <br /> D . RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: /✓ <br /> (J. - <br /> 1 JGn . � - &A Ve <br /> Contact Person: T)I�WOy' � G cZ,4!1 I EVA - Phone: gccl - 521 - 4I z7 <br /> Physical Address : 31283 a t$ ✓ IWO4,I-II KAntJeStU CA Q5350 <br /> Mailing :address : SQ.r U O-S GCL-Q JP <br /> E . DESCRIPTION L / <br /> Type of Discharge : IIY1ClU. ✓ I ?P� �FiI C�ISe I DW1 «� <br /> Volume : 0 WLV) <br /> Chemicals: I vn ' <br /> Circumstan es : OOVL .VVlflfioVj 4LtC Ve✓e � k�✓ I S( 1Ls !✓Yt ( ttMIG <br /> VfANIDVCt,QS WG'F QMGI �zedlLv� d ✓ rsinliS sUb✓vtt + k roE++ � <br /> F . ACTION TAKEN r VILE - LOP fby t UV� ltP� 55ZSSyviP�Vf . <br /> U\3 LD ±LQ D <br /> SITE DISPOS ON Ue <br /> Y ei1G <br /> ( I V - LOP <br /> EH 22 01 ; (Rev. 08/20/98) <br />