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SAN JOAQUIN COUNTY <br /> 4 NOTIFICATION OF HAZARDOUS WASTE DISCH@GE <br /> HEALTH & SAFETY CODE 25180.7 r' O <br /> 4_ <br /> A. EMERGENCY LEVEL: I I Pne) <br /> PHS-EH LOG(Circle <br /> B. SOURCE OF INFORMATION ti <br /> k <br /> Name: 5. Ar c D so.0 G. Phone: (!L/,2j.337.ST 3a <br /> Company: _ <br /> Address: //15 G¢ G1' r�5'a i . <br /> Designated Employee Name: Phone:;;) <br /> Reporting Agency Name: <br /> Address• k <br /> C. LOCATION AND DATE OF DISCHARGE <br /> ' Location: SoI <br /> (Best Physical Description) City or County),Circle One <br /> Date of Discharge: 61,0C <br /> Date Notified: 11- ,111-f5 Time: 3 oa <br /> D. RESPONSIBLE PERSON/BUSINESS D y b f <br /> Name of Business: IV fes'ac/b Es GE a 440vm /Al c ; <br /> Contact Person: AACOL -5 /30;k-'eDCs , Telephone: ( `3)- _ 3 �zc�/I <br /> Physical Address: Z�e 2/ A) 2>C a rnA-) G¢ za <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: 12AL<A1 --- <br /> Chemicals: 6 /v6 <br /> Circumstances: 6X#-vA 4s C�r <br /> l,rbc ,w �, - Z <br /> F. ACTION TAKEN i- S17-e E075y� 6AJ <br /> SITE STATUS <br /> l- <br /> c ,. <br /> EH 22 013 (Rev.4/91) . <br />