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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 C cu) <br /> A. EMERGENCY LEVEL: �PII III PHS-EH LOG # 5�-' l3 <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: -- 41V r� Phone: C3! 4"07' 22<� <br /> Company: Aezz> <br /> o7 <br /> Address: /'D- 3:ax 6,P351- <br /> Designated <br /> ,P351—Designated Employee Name: Phone: �) <br /> Reporting Agency Name: <br /> Address: 4,�W-S tel. s.9,�j TcyA 4rrn1 s s�c,�Ta� �9 95� / <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: <br /> (Best Physical D cri 'on) (City ofzMi—�ty) Circle One <br /> Date of Discharge: //:? f 3 <br /> Date Notified: Time: 3o -,-I <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: _ D <br /> Contact Person: �� �� �9 /' r2� Telephone: <br /> Physical Address: <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: <br /> Chemicals: <br /> Cir <br /> cur}Zstances: o .46'D,v ,,,G4v,�- �.v�n ��is mom% izs ,e�•� <br /> , t 1k4G•A;�4sE <br /> F. ACTION TAKEN .Zia�GGG7 <br /> SITE DISPOSITION <br /> EH 22 013 (Rev.4/91) <br />