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SAN JOAQUIN COUNTY I�- <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE C t' <br /> O <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY' LEVEL: I II III PHS-EH LOG # fr -37/ <br /> (Circle One) , <br /> B. SOURCE OF INFORMATION <br /> Name: Phone: ( G r- 9Z3 <br /> Company:��' a r �✓ 1.. 7�c roc o c <br /> Address: .z=s 9S 3� <br /> Designated Employee Name:, �c,�..ta KI sr_ __ Phone: Cto�r) 4 -033`/ <br /> Reporting Agency Name: - <br /> E <br /> Address: Um a n <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: <br /> (Best Physical.Description) (City or County) Circle One <br /> Date of Discharge: s4ri _. <br /> Date Notified: 0 2-f—f_3 Tirrie: 3t� <br /> D. RESPONSIBLE PERSON/BUSINESS J i <br /> Name of Business: _ J 1 v _� v� c s <br /> Contact Person: _ .5��-� i ��K Telephone: (YADD S31-921f <br /> Physical Address: <br /> MailingAddress: v -c b 4 mac:see, l+, / -- 3 76 S <br /> E. DESCRIPTION ago/f r�rX <br /> Type of Discharge: <br /> Volume: __ vvl11_ <br /> Chemicals: se <br /> Circumstices* v -x/-43 • o. <br /> ► mr1 ` -,41v -7. <br /> F. ACTION TA7�N All w <br /> / #0n v Z3 <br /> SITESTATUS <br /> EH 22 013 (Rev.4/91) <br />