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RECEIVED <br /> SAN JOAQUIN COUNTY AUG —8 2003 <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE ilpy <br /> � t � aNa1m N�/nWlNi ll{�t}sill <br /> HEALTH & SAFETY CODE.25180.7 IfiCE.OFEMERGENCY SERVICE <br /> A. EMERGENCY LEVEII III PHS-EH LOG# <br /> L 03-a�a <br /> ucle one) <br /> B. SOURCE OF INFORMATION <br /> Name:_S�t t� PVN(*0-1 Phone: Qpj) y g z T3 y a <br /> Company: S4r-j T7D4M, In La ig 'SOF <br /> Address: <br /> Designated Employee Name: PAf V07,J / _Pho= Zip <br /> Reporting Agency Name: jjApv '3 a &.At Ga Nya<rr� Jr1sa�(,Y/ /1L j4ep� <br /> Address: 30�1 B W-042 r ,tae{ r 2=0 Gla--t— <br /> C. LOCATION AND DATE OF DISCHARGE <br /> J <br /> r. Location: 761 ►�prpA b VVI) / �7v4�•r� , �!�Z�� <br /> (Best Physical Description) (City Cour Circle one <br /> _ Date of Discharge: <br /> Date Notified; b� Time: `OD <br /> _ D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: S f t �R N i l t�eGl <br /> Contact Person: Ci } Phone: Ai it <br /> Physical Address: N u-tJ i C Z <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge:_ <br /> Volume: N VL <br /> Chemicals: IL V^ <br /> Circumstances: <br /> F. ACTION'`I'AKE1 <br /> k <br /> SITEDISPOSITION �ku fAj A(Oillert+24- C4crjfC <br /> EH 22 013(Rev.08/20/98) <br />