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u w ..•.:n.I ...r�_rr i r Rui <br /> F'.1 <br /> r � I✓ <br /> SAN JOAQUIN COUNTY 44 <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE 1W 9 1996 <br /> ►. HEALTH & SAFETY CODE 25180.7 <br /> SANIOAQOIN GOLR7;y� I <br /> OFFICE OF EMEROENCy S[RVICES _. <br /> A. EMERGENCY LEVEL:CIE�ft III PHS-EH LOG # Cl 'X31 <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Phone: ( ) c1rn <br /> Company: ca . •S <br /> Address: <br /> Designated Employee Name: Phone: (_) <br /> Reporting Agenc Name: <br /> Address: 3�� re-645e <br /> Av E_ S s GNU rb. CA 9S?v <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: <br /> (Best Physical Dgsc peon (City or County) Circle One <br /> Date of Discharge: Ss�9' tli�E <br /> Date Notified: Sr 9 Time: :7 , <br /> 23 ar.y <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: r! T �+- _ _ <br /> Contact Person: /t9/G_e4t/ io9 E� Telephone: (to!7) 9411- 836/ <br /> Physical Address: <br /> Mailing Address: 00 O 94,>,IC bvoio STOG�3"� G4 '�iSzi� - o0/0 <br /> E. DESCRIPTION <br /> Type of Discharge: -5�0iX/ <br /> Volume: � 8o G dcv,S <br /> Chemicals: X2/ <br /> Circumstances: AA -vT/ o�'iFi 7 of /.F�4S ,Q7 0 T- <br /> F. <br /> F. ACTION TAKEN --s .� l�Qr�� o S,4.,". 4 :*J -r,-� A04ilt <br /> SITE STATUS A <br /> EH 22 013 (Rev.4/91) <br /> AUG-99-1996 1607 96Y P.02 <br />