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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: II III PHS-EH LOG# <br /> Pircle <br /> one) <br /> B. SOURCE OF INFORMATION <br /> Name: PAVI 01) cuN Phone: I bbb <br /> Company: <br /> Address: S37 . RIO- 2 <br /> Designated Employee Name: tw Phone: <br /> Reporting Agency Name: T,0q"', fle, u ll�• •�• <br /> Address: 30'x! �/`/¢ -- U 2 r 1Cl�rtst. cStuL lLL+ (/� L <br /> C..,.- LO_ CATION AND DATE OF DISCHARGE <br /> Location: <br /> 115( W i UvyA, A vim. AA4-p j -eC <br /> (Best Physical Description) ( i r County) Circle one <br /> Date of Discharge: V N ILn0MM <br /> Date Notified: Time: <br /> D. RESPONSIBLE PERSON/BUSINESS f <br /> Name of Business: e 4r 02 ����'f <br /> Contact Person- <br /> Physical <br /> P-P d g-L* �` Phone: Zle:)-- �!7�t <br /> Physical Address <br /> Mailing Address: o D <br /> E. DESCRIPTION <br /> Type of Discharge: C`J d l <br /> Volume: N 1Lw w <br /> Chemicals: T 13 I <br /> Circumstances: r., <br /> F. ACTION TAKEN-0 T 6� <br /> SITE DISPOSITION <br /> _ I <br /> EH 22 013 (Rev.08/20/98) <br />