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7-29-1997 2:50PM FRO,v I P. 6 <br /> SAN JOAQUIN COUNTY A 2 91997 <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARG <br /> HEALTH & SAFETY CODE 25180.7 saN�o - <br /> AM COUNTYOFFICE OF EMERGENCY SERVICES <br /> A. EMERGENCY LEVELC III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: o �� Phone: (T�) <br /> Company: ti w Go <br /> Address: OAC'� 2M�''7 <br /> Designated Employee Name: Phone: (� <br /> Reporting Agency Name: <br /> Address: 56� w SG Avc 5 04 �'SZo� p ( 7 <br /> C. LOCATION AND DATE OF DISCHARGE 1 <br /> Location: goo A- 4pq,. > <br /> (Best Physical Description) (City orCUOun Circle One <br /> Date of Discharge: <br /> Date Notified: Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: <br /> Contact Person: G4 elephone: CZa ado- <br /> Physical Address- 9ca Al. 5al4w ,C�.1�� r-nater rt w/Sz.iS <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: /a4o y <br /> Chemicals: rav65�G- �aEG <br /> Circumstances: t o yi oR P � o7-i�-�E� 6b p'rs <br /> F. ACTION TAKEN i�G �iGG ' Sot. aE Jho.-i A TR4G�G- 73�a �L <br /> curl S �d 77�LE TiiPE ,p��7: OR7[2� o S�it[�✓� <br /> SITE STATUS r�Qc�G. sS7 o Go a%� GG6o Co.sS <br /> r./ eveS7o�GtS� r 4 EL <br /> Eu 22 013 (Rev.4/91) <br /> ,� JLL-29-1997 14:55 96i P.06 <br />