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SAN JOAQUIN COUNTY �C\� <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> C <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Phone: <br /> Company: <br /> Address: <br /> Designated Employee Name: phone: - 4 <br /> Reporting Agency Name: n 7 i& N ea i 4h -n u N eekl N IS f 1. <br /> Address: 3o UJe r F, 4 Sze <br /> C. LLOCATION <br /> 1S =—j&e14'DISCHARGE`q wu w <br /> / Sirovl�� <br /> (Best hysical Description) (Cityo ounty le One <br /> Date of Discharge: U(n��rlaw�'1 <br /> Date Notified: 12- -5T Time:A$' <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business M t <br /> Contact Person: 01 Nei( Telephone: /O 7Qg -336 <br /> Physical Address: a, t 1 C44 .2 3 <br /> Mailing Address: SA,VvP, as a <br /> E. DESCRIPTION <br /> Type of Discharge: IG nt-y7� <br /> Volume: _ <br /> Chemicals: <br /> Circumstances: i y _ <br /> tK hF p u l <br /> 444 (19-+, "#re.4 e zsf -t{nt pm perfy <br /> F. ACTION TAKEN <br /> h <br /> culor?, 11 s" i Ur <br /> SITE STATUS Sr a n. o <br /> rW--Q v- U S2SS h elk u'PLI <br /> EH 22 013 (Rev.4/91) <br />