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SAN JOAQUIN COUNT! no <br /> NOTIFICATION OF HAZARDOUS WASTE DIS <br /> O* <br /> HFA,TH g SAFETY CODE 25180.7 UF <br /> A. EMERGENCY LEVEL: I II III <br /> PHS-EH LOG r 19 D ?0z <br /> (Circle one) <br /> B. SOURCE OF INFORIMATION <br /> _ Phone: ( ) <br /> Name: - <br /> Company <br /> Address: z zz s0✓rrr iC!vc RS 10� �G1�zA SrCT //OCJ CH/C'ffL D,/ � <br /> Designated Employee Name: <br /> Phone: <br /> Reporting agency Name: N T)f'r )/� flHS/— --_t'70 1 — <br /> Address: �.7 F, � S T 6 N C H <br /> C. LOCATION .A D DATE OF DISCHARGE, ID <br /> 01504 #etr/g/1 f- �"Cg c� ��� <br /> Location: i )t- ircle one <br /> (Best Physical U2/pnoa) <br /> Date of Discharge: S 2 ! 9 q Time: 3.•00 TM <br /> Date Noa[ied: <br /> D. RESPONSIBLE PERSONIBUSIINEESS <br /> Name of Business: 7' a "/rI t(al4L <br /> 6Gie6C- pF nJOLe Phone.?/ i zoo j—/ <br /> Contact Person: r v�srUE rVLAZA , S J/TE I r00 : CNlCAE;p <br /> Physical Address: 2z SaU>H <br /> Mailing Address: A ° <br /> E. DESCRIP'T'ION <br /> Type of Discharge: <br /> Volume: N N <br /> Chemicals: SBO N 7�rne�CH e v !Oc %N D�/NK//UL� tJc(L O u S/7, <br /> >Pin 5; ARIES Ui4Rlo�'S <br /> Circumstances: 17/ /r5U <br /> w/�7�2 sf�i'�Pc�s ti. OOhtcr'Tc C cL a NoLP/ vL lKAIK tc1l <br /> CONN 6�is tv NIr:C� <br /> F. ACTION TAKEN <br /> SITE DISPOSITION rJCTFl�� ,455i�SSM� O F �� � 7E/?�UlCOR��� <br /> C S <br /> lLc.sL) -is dr At !z sAMi'[.�.5 f•�-'[?awl !/U�C�- �- Nay- rti 7f�,tiK <br /> 2 3v 2 d <br /> EH 22 013 (Rei'. 08120/98) <br />