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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE Co <br /> HEALTH & SAFETY CODE 25180.7 Lf <br /> A. EMERGENCY LEVEL. I II III PHS-EH LOG # <br /> cle One) <br /> B. SOURCE OF INFO ION <br /> Name: �Z - U Phone: �1 3 6 ` '=--T7 I 1f-) <br /> Company: ��� � ' ��-c-� Y_ '' - P <br /> Address: 3 �` q,S- 20Z <br /> Designated Employee Name: Phone: �) <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE _ <br /> Location,1±\ G tee+ I t So' t%O,S+ atg- C C <br /> (Best Physical description) ((City G`ounty) Circle One <br /> Date of Discharge: I ''/1 �� <br /> Date Notified: „ AD'S i � ,_( C� Time: /C' '. 0 0 n� <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: 41.1 b l <br /> Contact Person: / .►' Telephone: <br /> Physical Address: S l--0 v" �'t l t.C�. (_ o <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: 11,E <br /> Chemicals: -v, n vn - -y"c; (-n Ktoa <br /> ircumstances: .c r 1r,` <br /> F. ACTION TAKEN <br /> SITE DISPOSITION ,-) n <br /> EH 22 013 (Rev.4/91) <br />