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lam►�t .� ��� 6 q P�Qed� <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> Iy ��� � <br /> A. EMERGENCY LEVEL: CL I III PHS-EH LOG <br /> (Circle One) <br /> B. SOURCE OF INFORMATION Phone: e68-3c? <br /> Name: :EFPd <br /> 169 <br /> Company: o • �• S - <br /> Address: Zz� w�dE -8✓� S7 o��7rxJ cA �r5zo / <br /> Designated Employee Name: Phone: (_) <br /> Reporting Agency Name: <br /> Address: V4* I/ 54r� 44��1•�l s ST�L�Jonl �/1 4ST� <br /> C. LOCATION AIND QATE OF DISCHARGE <br /> Location: 0-/c7/ Z+,'-- <br /> (Best Physical D sc 'pdon) (fir County) Circle One <br /> Date of Discharge: 9 9Z <br /> Date Notified: _ 9 4 Time: a!n <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: 64/6, -Z-Me Fav 5 �D <br /> Contact Person: 1206r- Telephone: (;In ) <br /> Physical Address: 7_ 1/o/ Y, i.4- <br /> Mailing Address: f' o 50>< /057 �eiQ1Y G4 9537 <br /> E. DESCRIPTION <br /> Type of Discharge: SRibL <br /> Volume: <br /> Chemicals: /�Gi 0 ,�/i��/l <br /> Circumstances: GiY �� ��• '^l ` SP/GL Tl�iFic.4?iax/ ��o�"I <br /> O• C • S. <br /> F. ACTION TAKEN S�/GGF� �/1� wA CaGG6c7E� 2.J .9�/ 0^1 <br /> B�iiN 1�.e Pti ADToST/s-F.�!! /a'FTFse-.a �S✓S%h %-�/✓� <br /> v<� /vif v��BD To i� ✓�iN6 Pv.✓ds Z, <br /> SITE DISPOSITION SaiEpf! ,5/ /ea �4T T3t .P•�-cr• c. B• irs45 a�6c/ <br /> EH 22 013 (Rev.4/91) <br />