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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> I <br /> a <br /> HEALTH & SAFETY CODE 25180.7 <br />{ I <br /> F <br /> A. EMERGENCY LEVEL: ;I II III PHS-EH LOG #_ o`. 0 „ <br /> ;p (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: ' �F S 2 '� Phone: f!2-),50(0- 1�r) <br /> Company: <br /> Address: �o7-7 'Eie- L;►rr Sa cy-6nieia _ a 5 8a-7 <br /> Designated Employee Name: Phone: �) <br /> x Reporting 'Agency Name: <br /> Address: <br /> C. LOCATION AND D TE OF DISCHARGE =- _ <br /> Location: =)MSQ L 1 - -o-L� <br /> (Best;Physical Description) (Cit)r or ount?jrircle One <br /> Date of Discharge: k-n-ulv� <br /> Date Notified:I� z z Z Time: -_ i f ' av a Yv-, . <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Basin'ess: Sato Gln nt L, CGc4e L <br /> Contact Pe sor : Kee-k�-r Telephone: ( )_7 y--2L U <br /> Physical Addre t om ?7� cjia c f . h,--r_w- G r-2-o z <br /> Mailing Address: <br /> E. DESCRIPTION�� <br /> ' Type of Discharge: Lkl/A �c u M c�+-1 <br /> I <br /> Volume: <br /> Chemicals: If 5a + e- <br /> f Circumstances: v t rS <br /> F <br /> - <br /> r <br /> F. ACTION TAS ISN — L i fc <br /> 4p !N <br /> SITE DISPOSITION <br /> > I <br /> ;w2 iN`r �-- a <br /> 'i S w ,de 2Jc6/ <br /> ii <br /> EH 22 013 (Rev.4/91�) <br />