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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> '?HEALTH & SAFETY CODE 25180.7 ` <br /> A. EMERGENCY LEVEL:0Ii IIIPHS-EH LOG # OC <br /> ��(Circle One) <br /> B. SOURCE OF INFORMATION F <br /> Name: Phone: FMI <br /> Company:_ Kleiveldev- _ <br /> Address: 3-L7-1 V4g— C.«c.1G Cf+.,4582 . <br /> Designated Employee Name: Phone: <br /> Reporting Agency Name: .il <br /> Ir. <br /> Address: <br /> I) 4 <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: (vo09 No►� <br /> (Best Physical Descripti n) City r County) Circle One <br /> Date of Discharge: 1 L),2LbkU <br /> Date Notified: 5�'2."z.q2 Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: _Ma �aIr ShapeC►'� r <br /> Contact Person: nb 13465 a Telephone: �)__45!- Z563 <br /> Physical Address: 14,o t Iii IJortln alPow- o Sfuc-tfrvi CA 5a 0 <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: v r e janiL <br /> Volume: �_nK�f?o►i:?,� <br /> Chemicals: <br /> Circumstances: `Thu d6tharcie became Kn�wa ..c�arcv�, M\J1cW ©& 7 ;W"_Limy}-erg. <br /> �r <br /> prQ.oaredbu 4(.l¢utiFc.(d[✓ avtid -UbnuW Bob $�cs,5 Z� <br /> F. ACTION TAKEN k I er rca . 5 dw <br /> tom.��R2 _.._ 1 <br /> SITE DISPOSITION I1' US 11 Coniwvw4 th VaM „ 12f,- c MJwext Wtf-�h on UAR j <br /> re-Por+ anti erl tb 11'a s R)k-thcK, <br /> �'1��5 rL 1Oi✓1 4Vt6 remedaf rl W t I Ui r-ecl . ?451,Ew 0wor , <br /> C \LLIP-4 &LOnid & Q�n.la; ✓+moo L t W ll lam <br /> 4 <br /> EH 22 013 (Rev.4/91) <br />