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SAN JOAQ UIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARC <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: Oil III PHS-EH LOG <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: -,_�eK En. /yI�['o LL ouq� Phone: (k ) 9VF- /15/* <br /> Company: ,8ET,4 KS3pCi 4TCS / �p2�e E }Q �j�� <br /> Address:-- mob f Z,,vco,1,j 41E. <br /> Designated Employee Name: Phone: (__j <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: _ _ /6.8/ AC,*; ou,e7- /,5rQcY-7-0 <br /> (Best Physical Description) ity r County) Circle One <br /> Date of Discharge: Olw< <br /> Date Notified: 6 .2 7-'71 Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: Li.vcoG,v <br /> Contact Person: A'Aeely 4 4,vb✓i'e- Telephone: (JL/-�o 5�/-2zoc) X Y,76 <br /> Physical Address: io/ L.Svc e C � � r� Lam,. C.�(. 95��D 5✓ <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: V/vk <br /> Volume: (DNX <br /> Chemicals: ro NE bbc" .Db 7-- <br /> Circumstances: PAAz-A.-= <br /> F. ACTION TAKEN Al/,O• 12 <br /> s4" ply <br /> -�ti cJ ice. c.-eti� <br /> SITE DIS! SI ION c, 'r c <br /> �,1 <br /> EI-I 22 013 (Rev.4/91) <br />