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Mav • 13. 2004 1 : 19PM Neil 0• Anderson & Assoc. No - 5090- P , 4 <br /> SAN JOAQULN COUNTY ���F <br /> NOTTF'ICATION OF EIAZARDOUS WASTE DLSC'9-A.RGE tRecEjVED <br /> H •LAI TIE( & SAFETY CODE 25180.7 <br /> A. EML EMERGENCY LEVEII Ill PHS-EH LOG= u SEHVIG�S <br /> (Circle one) <br /> 3. SOURCE <br /> _OFINFOR�IATION <br /> M /jz <br /> arne: c 'A f,-4,_ /� Phone: ( ) <br /> Company <br /> Address: <br /> Designated Enplovre Name: Phone: <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location. I030 S. Oli'y4, Am -Jz�-t-DC4 SZJS <br /> (Best Physical gescr p on) ;Cir •) ounn' irdz one <br /> Date of Discharge: <br /> Dace Notified: Timc: <br /> D RESPONSIBLE PERSON/BUSLNESSS <br /> Name of Business: A 7 <br /> Contact Person: fV1,'r Phone: .f-O 777,700 <br /> Physic,:) address: 7 �f,,gk1� • -S <br /> i% 91V-71TIR <br /> ivL„Iirg Address: S/+m T <br /> E. DESCRIPTION <br /> TNpc of Discharge: _ <br /> Volumt: <br /> Chemicals: <br /> Circumscinrs: <br /> F. A ON T. <br /> SITE DISPOSITION <br /> J <br /> EH 22 013 IRev. 03/20,99) <br />