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f <br /> h0 ,.. <br /> s <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I It III <br /> � PHS-EH LOG <br /> (Circle One) <br /> B. SOURCE OF INFOPuMATION Phone: CIL03 c./O 7- Z6oq <br /> Name: -I-' /je2/ 1 arls <br /> Company: A 44-D 3 ya7oz <br /> Address• ;;7,C> o� x <br /> Phone. (-.J <br /> Designated Employee Name: <br /> Reporting Agenc Name: S� S Zo <br /> Address: 4�K <br /> C. LOCATION AND DATE OF DISCHARGE s� v <br /> TMQ =L1 <br /> oo � _ <br /> Lcatin: /� ��'� `"���'`{�� � (City Circle One <br /> (Best Physical Dec pti9�� <br /> Date of Discharge: l <br /> Date Notified: 71 /z Time: -7 ,0 <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: Telephone: 3 e SEo 7 ZA- 2 <br /> Contact Person: P - <br /> Physical Address: -7 ZE � <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: S�iG <br /> Volume: G -r- <br /> Chemicals: � <br /> So off <br /> Circumstances• <br /> 14- OA <br /> �� S df3'`r� !" S <br /> F. ACTION TAKEN .o.�dv�•T ��'�� �E,��.�/G -z� �is��'��E2---",'�------ <br /> 3ltFr�l�Doc�it� �rG`F� CSS !y S Gok <br /> Gs4S <br /> SITE DISPOSITION <br /> X <br /> EH 22 013 (Rev-4/91) <br />