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1i <br /> M <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE FILE COP Y <br /> HEALTH & SAFETY CODE 25180 . 7 <br /> A. EMERGENCY LEVEL: II III PHS-EH LOG # <br /> ( 1rcle One) <br /> B . SOURCE OF INFORD4ATION <br /> Name : / A4- tt Phone : U ��FL- 869S <br /> Company: Co . <br /> Address : Rc,, CFS `rKS83 - 69a <br /> Designated Employee Name : Phone : �) <br /> Reporting Agency Name : <br /> Address : <br /> C . LOCATION AND DATE OF DICHARGE <br /> Location: 46 (, o L wev C ) - <br /> (Best Physical Description) Kity or County) Circle One <br /> Date of Discharge : ( v <br /> Date Notified: j2 l B Time : 0o .4 •ul <br /> D . RESPONSIBLE PERSON/BUSINES <br /> Name of Business : C44 "— �OOe Co ' <br /> Contact Person: Telephone : fELO P(L - 89S <br /> Physical Address : <br /> Mailing Address : '5 <br /> E . DESCRIPTION <br /> Type of Discharge : /vvti LQ <br /> Volume : <br /> Chemicals : <br /> Circumstances fG w eaw.urR v � � w <br /> F . ACTION TAKEN 3 At; Q aAAJ oil - w S <br /> SITE STATUS v� S_d . Ce . L • • tom• <br /> W . P <br /> EH 22 013 (Rev. 4/91 ) <br />