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Iqw <br /> SAN JOAQUIN COUNTY t t <br /> NO-nFICATNA OF HAZARDOUS WASTE DISCH '��. <br /> HEALT'rt & SAFETY CODE 25180.7 ; �, <br /> A. EMERGENCY LEVEL:0I R III PHS-EH LOG # o� <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Phone: („_) <br /> Company: F& L �• <br /> Address: '2560 C04ACk s t �"— <br /> Designated Employee Name: •• Phone: (a") Y- 0"-0 <br /> Reporting Agency Name: 54'% •+ -001 _ to lP its — C-1 A� _ -- <br /> Address: y Lf S N• San10.4;V1.1 'S ho` �.-, <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: J S ev 5 P f"sc++,�.� ,fre /t+�, / <br /> (Best Physical Description) {City o Cirs2a One <br /> Date of Discharge: 0'v <br /> Date Noticed: <br /> D. RESPONSIBLE PERSONUSINESS <br /> Name of Business: veer V.k a cam► r MN- <br /> Contact Person: Q rut AALM k.eea Telephone: ( �r'�� •2Y� <br /> Physical Address: sx- sc e,lo tl.o r=f. tom' <br /> Mailing Address: <br /> E. DESCRUMON <br /> TAm of Discharge: �; •••• <br /> Voltam: <br /> Chemicals: <br /> Circumstances: ✓� .r,E w• <br /> F. ACTION TAKEN <br /> r CL <br /> ;. <br /> SITE DMVOSMON / A:,3 0 WAS <br /> 44 e <br /> c+r V <br /> EH 22 013 (Rev.4191) <br />