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SAN JOAQUIN COUNTY <br /> G NOTIFLCATION OF HAZARDOUS WASTE DLJCHARGE <br /> HEALTH & SAFETY CODE 25180 . 7 <br /> A_ EMERGENCY LEVEL: I II III PHS-EH LOG ;# * �/ : JV� <br /> (Circle One) <br /> B . SOURCE OF INFORMATION <br /> Name: ,a-U-vtM_ a o� , ( C ( i ! c 9. Phone: go Y 5 -7j <br /> Company: Geo <br /> Address : .1 + 0aA� five, C lqo <br /> Designated Employee Name: F ' Jgrl Phone: U&T Afk <br /> Reporting Agency Name: <br /> Address : <br /> C_ LOCATION AND DATE OF pDISCHARGE <br /> Location: 3 / "1 S , P � Do- cc Jo / S <br /> (Best Physical Description) (City o Counry) ' cle One <br /> Date of Discharge: G�? ��yLr92rJyv <br /> Date Notified : Time: �5 . ' o�✓� rn > <br /> r <br /> D . RESPONSIBLE PERSON/BUSIN SS <br /> f <br /> j Name oBusiness : VaAlL ?d-e ry4 �cG4�&o <br /> j Contact Person: DPr `f" Telephone: ULD bra 3 a f <br /> Physical Address: 3 f 51 7 S . ct Dpi cCn <br /> Mailing Address: D , /3� u l I /o 7 � SY"�v f`4zq�� G/9 q z5an <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume : <br /> Chemicals : D ' _e Sc e MTBF7 <br /> Circumstances : <br /> F . ACTION TAKEN 4t J . <br /> 5 = <br /> L V=i <br /> r <br /> SITE STATUS - <br /> EH 22 013 (Rev.4/91 ) <br />