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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:I)II PHS-EH LOG#Q y ^ Q <br /> ircle <br /> B. SOURCES�qOF INFORMATION <br /> Name: LUV1 �� DY Ls Phone: iT- �t cl - <br /> Company._t� a� 1 r. ffD <br /> Address �,6 D of l t9f 1 eon_ <br /> Designated Employee Name. <br /> Phone: <br /> Reporting Agency Name: ',.k 1, <br /> A <br /> Address: :5pL( £ t )o�on ,¢ K ra f: <br /> �o r t•1ca�,`, <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: (o(5 1 L �Ael^� A- <br /> (Best Physical cription) Crh, r County) Circle one <br /> Date of Discharge: n h <br /> Date Notified:�y�y 4 Time: 3 J <br /> =ala <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> NameofBusiness: &46 � A �keet J-vtdeS -p(- <br /> Contact Person: 1 <br /> 05 �e(iSse�.• Phone74q_) LI4;3 — r., 08 <br /> Physical Address Yo <br /> Mailing Address. <br /> E. DESCRIPTION <br /> Type ofDischarge:��LaU f;>.J <br /> Volume: 160Qpe s <br /> Chemicals. <br /> Circumstances:- f L 01- <br /> F. <br /> rnF. ACTION TAKEN ()N 0U.,E_ G ���I��s rp p <br /> SITE DISPOSITION <br /> EH 22 013 (Rev. 08/20/98) <br />