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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCH E COPY <br /> �HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I JII III PHS-EH LOG <br /> ercle one) <br /> B. SOURCE OF INFORMATION <br /> Name: 4eeo-e— Phone: ((/�pj2SS- <br /> Company: <br /> Address: <br /> Designated Employee Name: Phone: <br /> Reporting Agency N�1ameL?y4YD ( U tq <br /> Address:? L3 r�ot�� r Q r �l Sw E P �(GJQVkZv <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: ( ( S 0L r a <br /> (Best Phvsical Description) (Citv`or County) Circle one <br /> Date of Discharge: ,(U.(6AUI -r) <br /> Date Notified: NYAd'G(A ( l 99 Time: 00.o22�,-. <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: �Je5+(-- <br /> Contact Person: Phon : I S 300 <br /> Physical Address: -:;Z6 E ✓ VN-A P\ to Iy(i n O ff jk 30 C7 <br /> Mailing Address: (P L=i4-ed'rvt r2 rti -0tk L-�(in o f{ 4 3c� (7 <br /> E. DESCRIPTION <br /> Ty <br /> pe of Discharge: <br /> Volume: (/(v�l�N ��lr <br /> Chemicals: '•r 6,1lLava2r i xvl� <br /> Circumstances:_ ",LLA-ey^ S,ao E �v� <br /> F. ACTION TAKEN <br /> SITEDISPOSiTION S ci�/ fe �1 �Q�✓ -fE.e Ov �/ Scyl - o� <br /> {f e GUR-W CRC, dgt* finbte3 <br /> EH 22 0l3 (Rev- 03/20/98) <br />