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SAN JOAQUIN COUNTY 1(.) \ ' <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL III III PHS-EH LOG # � <br /> cle One) <br /> B. SOURCE OF INFORMATION <br /> Name: )an I e I at'd rson Phone: cZO� 3544-1OH) <br /> Company: e75 Envircnm�n-�zd <br /> Address: Z2 l Me�rce_d CA 95-�L4C) <br /> Designated Employee Name: Yo-p j U t b l e-�4- Phone: LAo 8-3LI b <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 101in -I�KVIOYn T)nVe- / ( Ki-c-� <br /> (Best Physical Description) Ci r County) Circle One <br /> Date of Discharge: KhOcvn <br /> Date Notified: 2 Time:_ 7:Q0 ?rr'1 <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: I I Khorn 6tyrl bfCLU <br /> Contact Person: •2 Telephone: (Zj) LI 11 - <br /> Physical Address: 1050 t I L--ht3- n Drives , -tfvc-E--Fc <br /> Mailing Address• -1Lv�t�2_ I <br /> E. DESCRIPTION <br /> Type of Discharge: l e-0, <br /> Volume: LC/Yl l� YIOu n <br /> Chemicals: Eo I I n <br /> Circumstances•. evlec.�-2 V Fcsi�nc b!^iZtt-pec <br /> i I <br /> F. ACTION TAKEN -1-aoY- Y-eiracllc-0 <br /> I <br /> I <br /> SITE DISPOSITION )4-T 0,mi f Gy1M i o c1 xn ins i l � o,-n w-ffQ1n l� N LNn <br /> (C V?,DC rk (1 mrd QrL fl Q C&w- x,vin t no 5,74e <br /> 'y4 -�Tl yl ilP�t c,�,f� G.v cl . Cid l c 4 !m! (� ✓2 .�� <br /> P_ l� t2Gf 5 <br /> i <br /> EH 22 013 (Rev.4/91) <br />