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May • 13. 2004 1 : 18PM Neil 0• Anderson & Assoc: . No.5090 P . 2 <br /> r SAN JOAQUIN COUNTY RECEIVED <br /> NOTIFICATION OF HAZARDOUS WASTE DISCRARGE <br /> HEALTH & SAFETY CODE 25180.7 Af1G 19 2002 <br /> SANJU"IN COUMY <br /> A EMERGENCY LEVEL: I II III PHS-EH t IAG O a = 1alrGlNCYSERVICE <br /> ( ,ircle one) <br /> B SOURCE OF NFORMATION <br /> ' Name. Phone: ( ) <br /> Company <br /> Address: <k3 7 's :26" �- a1,zI S— <br /> __ Designated Employee Name: Phone: <br /> Reporting Agency Name: Ggl,lc rev. .k.S <br /> Address: q 04 y W&tcAo <br /> C LOCATION AND DATE OF DISCHARGE p, Sal 5 <br /> SkLocation: a _ (1 t H Q4>'c' /_ C:-F-r� <br /> (Best Physical Description) (City or County) Circle one <br /> Date of Discharge: <br /> Date Notified: Time: <br /> D. RESPONSIBLE PERSONBUSINESS <br /> m <br /> Nae of Business: GNipGI' <br /> Contact Person V 1e d Phone: <br /> Physical Address: �(oUQ - 9S <br /> Mailing Address. PU o-vC a (a-1 IVL4tA 11 Wet CA —q S{4 ��'" <br /> E. DESCRIPTION <br /> Type of Discharge: () ' kt-';If�u-k <br /> Volume: II V�- <br /> Chemicals v4L e cm4en A*S L�saw- <br /> Circumstances: <br /> F. ACTIO TAKEN o p rR, O 1P f Dc A FYtti xrS+ Ja��Lo a- <br /> SITE DISPOSITION Uw�r2 lam! tlxl <br /> EH 22 013(Rev. 08/20/98) <br />