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SAN JOAQUIN COUNTY D <br /> NOTIFICAL-0N OF HAZARDOUS WASTE DISCHARGE <br /> E-=--%-LTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: CiII :,1 PHS-EH LOG #_ <br /> (Circle Cue) <br /> B. SOURCE OF INFORMATION �y <br /> Name: C,((`�-Q c Phone: c� <br /> Company: 6$ ±4 or,- Seo ��cT7� — i c. ,_ .4 s } , <br /> Address: 9 9 % D S ,�-ee4- -7E- <br /> Designated Employee Name: Pho e: y O <br /> Reporting Agency Name: S _ Q�D b b C-� <br /> Address: - <,-TO G BUY) CA.-� , ?S <br /> C. LOCATION AND DATE OF tOESCHARGE <br /> Location: q01 D E t,-% S S—' 6 <br /> (Best Physical Desc prion) (City or County) Circle One <br /> Date of Discharge: 0 N IC wo w ri <br /> Date Notified: 9- S.8- - Time: : 0 ,6 <br /> D. RESPONSIBLE PERSON/BL+,.L ESS <br /> Name of Business: -77C:lP-e <br /> Contact Person: Telephone. :217----7-- <br /> Physical <br /> � Z� <br /> Physical Address: "� % -z� •� S cT— <br /> Mailing Address: A `�A'. 6 � <br /> E. DESCRIPTION <br /> Type of Discharge: ( <br /> Volume: d /1J <br /> Chemicals: a <br /> Circumstances. - !2 �('nt v S Sb <br /> F. ACTION TAKEN__,,2, r2tiV <br /> SITE DISPOSITIOrd ' vJ 1 ( <br /> w rrh " 42--, ►� <br /> ,ore)Or-LOALK" <br /> EH 22 013 (Rev.4/91) <br />