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SAN JOAQUIN COUNTY ,. <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARU'"IJ -1 J <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:, II III PHS-EH LOG# p OS J <br /> (Circle one) <br /> B. SOURCE OF INFORMATION <br /> Name:. ai,, , SSe�L Phone: Vx) <br /> Company: C�� �k yet" a,,- �;r e <br /> Address: <br /> Designated Employee Name: Phone: <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE 1 VlOF DISCHARGE <br /> Location: q( q z- laA <br /> (Best Physical Description) (Ci or County) Circle one <br /> Date of Discharge: (co (6 �o <br /> Date Notified: 1c) 11t, f o l Time: -V- <br /> D. <br /> D. RESPONSIBLE PERSONBUSINESS <br /> Name of Business: �w ck P -�ro(eyw- <br /> Contact Person: Phone: 7-3(j-�j -2$ <br /> Physical Address: L(t Ci s: . K S�Ce¢�t Itila V1*c,�, t-lr� <br /> Mailing Address: Q_O. g CA S S S <br /> E. DESCRIPTION <br /> Type of Discharge: DA&4j <br /> Volume: UV-1%ueu}01 -- <br /> Chemicals: !S Ca.0U V-0— <br /> Circumstances pw QL; olti <br /> a*0 0. <br /> F. ACTIONTAKEN L),d ,, t. ,,4.e. <br /> SITE DISPOSITION J N. Ag 02 S <br /> EH 22 013 (Rev. 08/20/98) <br />