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• SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISV r COPY <br /> HEALTH & SAFETY CODE 25180.7 11GJ <br /> IA. EMERGENCY LEVEII III PHS-EH LOG / ` O <br /> cle one) <br /> B. SOURCEOFINFORbIATION <br /> Name: �o rre.J F1 P�2V`e Phone: ,[p <br /> «) 2 30 S C <br /> Company: <br /> Address: <br /> Designated Employee Name: Phone: <br /> Reporting Agency Name: e -IA Q <br /> Address: 34: j f2,6 r e-y' r Su �1 P SG V Ct✓��> c i9 G S-Sf�7-3Z��j <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: <br /> 33 (-?O ra a v� <br /> (Best Physical Description) itv or County) Circle one <br /> Date of Discharge: L4 A V--YL 5-voY,\ <br /> Date Notified: Mar r,I� 1 I I q 9 T'me: 3•Qa �� <br /> D. RESPONSIBLE PERSONIBUSINESS <br /> Name of Business: Q <br /> Phone <br /> Contact Person: <br /> Physical Address (oi �4-}PVWiQ0 ^v. L ` _ u L nI <br /> Mailing Address: (a(02..S �1+F er VV 1 Y� (o I M �H F 3o i 7 <br /> E. DESCRIPTION <br /> Type of Discharge: S <br /> Volume: A-6-ti`A \ <br /> Chemicals:Tfi (U 2k e 12 GIS — I 2 �1 c lr a 4 In e�l e <br /> Circumstances: {-avm"Y�&tw .4 -'G-A—�� <br /> LV R W L(� IVes3 4z uustr a Fri <br /> F. ACTION TAKEN <br /> SITE DISPOSITION <br /> 4t-, tJ W QC-A 4:1,5, 1 C.k"w U19 CSM �I WaS <br /> EH 22 0l, (Rev. 08/20/98) <br />