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16,00 <br /> a* <br /> SAN JOAQUIN COUNTY - <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 ` <br /> A. EMERGENCY LEVEL: I II 6 PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: SC�ur�rt �itw��, �r'c 4 / --- Phone: C <br /> Company: <br /> Address: YJ e e A c 't e + 4 4 Y�163 <br /> Designated Employee Name: a,riur a �- Phone: ( J) Y6a'--03 3`/ <br /> Reporting Agency Name: <br /> Address: 14 yJ v. <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: -7-7-7 L coc u 5)— / °41 <br /> (Best Physical Description) i r County) Circle One <br /> Date of Discharge: ._ z," � <br /> Date Notified: d3—A/ —g I Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: �✓e�✓L°� ✓� �� <br /> Contact Person: Telephone: <br /> Physical Address: �5 �G <br /> Mailing Address: <br /> E. DESCRIPTION p <br /> Type of Discharge: Y�cw�r�zee 74-t- //mss •/ 4n <br /> Volume: inc,r•� <br /> Chemicals: 4 V ,f / n <br /> Circumstances: <br /> F. ACTION TAKEN e cJC s <br /> f j C t�v 16v- o cart <br /> Z S 7 <br /> �4l• Cr �f Air t. <br /> SITE STATUS .�✓ fti r r,es °ems v�'l u,`, i <br /> �;rc/�we w418.�1�.orirrQ n <br /> EH 22 013 (Rev-4/91) <br />