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SA.N JOAQUIN COUNTY <br /> NOTIFICA1wi4 OF HAZARDOUS WASTE,r DISCf tGE <br /> HEALTH & SAFETY CODE 2514Q.7 <br /> " <br /> ►I �I <br /> A. EMERGENCY LEVEL:Q II IIi PHS,:EH LOG # <br /> (Circle One) <br /> Ij <br /> B. SOURCE OF INFORMATION <br /> Name: _ 6 ,P.tn+- Pye1 _ li° Phone: <br /> Company:----, N II II <br /> Address: Si ted- G-Lcxz7 cAi-t,P rxA jr, g<10-7o <br /> Designated Employee Name: II I Phone: <br /> Reporting Agency Name: If <br /> Address: 11 it <br /> II. � <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 1 I.12_ 4,r " L►aQ kms' <br /> (Best Physical Description) I �or County) Circle One <br /> Date of Discharge: <br /> Date Notified: Q Zrh -_ - ._-• Time:_ E <br /> D. RESPONSIBLE PERSON/BUSINESS I <br /> Name of Business: Ptv2ro -- <br /> Contact Person: gyj 's 1:�, - 0-yaen 11 Telephone: 64K) 15711 --24-&0 <br /> Physical Address: <br /> E 'I <br /> Mailing Address: P.o.flxrL 11 c 4 ado?— <br /> , I � <br /> E. DESCRIPTION <br /> Type of Discharge: Ul tA <br /> Volume: x tJrGt Ow&A --- <br /> Chemicals: <br /> Circumstances: <br /> F. ACTION TAKEN 9ej1&- � Few G-,2�u�� tames 7�n, r�2►,�.Y, e'_Mtb <br /> II. ; <br /> i <br /> SITE DISPOSITION SMS MS <br /> r <br /> - 1I II <br /> I , <br /> EH 22 013 (Rev,4/91) <br /> i <br />