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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II III EH LOG# O �D4S <br /> (Circle one) <br /> B. SOURCE OF INFORMATION <br /> Name: ftkvlv0+KD Phone: (IM) 0010 0 <br /> Company: {1 L r 1erz- t itc, <br /> Address: .NY2D 5 35 1 <br /> Designated Employee Name: ���� �x��'� Phone: (Z�°I 'C¢ �a_ <br /> Reporting Agency Name: cS GWi, YL <br /> Address: &O E. U) o r L 64 <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 0.(1Gt t n ' 1 SADA <br /> (Best hysical Description) C§00 <br /> r County) Circle one <br /> Date of Discharge: U k-n 0 LU Vl— <br /> Date Notified: Z_7 f D 3 Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: LO YOl <br /> Phone: Zfl9 UD q-100 <br /> Contact Person: cT11^� Y(,t n 8520�- <br /> Phvsical AddresLyyK, r- <br /> Mailing Address: PD 50X X100 s-t-peK-lvn CAS g52o1 <br /> E. DESCRIPTION <br /> Type of Discharge: LtS01 i tnG <br /> Volume: kw)vw V\- <br /> Chemicals: <br /> Circumstances l)S �voVGL <br /> F. ACTION TAKEN { <br /> •► � .„�� r�1��*� i•eta �t,ytk <br /> SITE DISPOSITION BU �- YCrnio`+� <br /> i+c i Gtw i 'rip <br /> EH 22 013(Rev.08/20/98) <br />