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SAN JOAQUIN COUNTY <br /> NOTIFICA�JN OF HAZARDOUS WASTE DISC.",.RGE <br /> HEALTH & SAFE'T'Y CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II rIII PHS-EH LOG # 173-o -7, <br /> (Circle e) <br /> B. SOURCE OF INFORMATION <br /> Phone: <br /> Name: <br /> L� <br /> Company: <br /> Address: <br /> Designated Employee Name: Phone: C�6 3--0 335' <br /> Reporting Agency Name: S,=�U`�n Ln(-),A P!�s - +6 <br /> Address: y I/ Z— <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: Z9 a i d, `-,t —/ M <br /> (Best Physical Description) (City or County) Circle One <br /> Date of Discharge: V�CC_vt o <br /> Date Notified: - l S - 4 3 Time: 1 t rw a <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: " a t V �+� <br /> Contact Person: Telephone: (z!�J) IS -17-Z� <br /> Physical Address: <br /> Mailing Address: P r <br /> E. DESCRIPTION <br /> Type of Discharge: Uhao .oit rel rel«S� �rorl 4!L v ncJvgrbv. � -Svc` S�nf�cc `�e,ti�S <br /> Volume: <br /> Chemicals: <br /> Catumstances �n nnS �4ti[Yr O1S OU2fC U 1� PP <br /> F. ACTION TAKEN -�•., �; �v �'�( r! I <br /> y — <br /> \ �cc� • 1 �-ef,--eco <br /> �'�nt, i1Q�1 l f1� ✓d` � � l+f 04( G N ? L� / M tC��a � r"7 v. - <br /> • VLA �\4 V� <br /> 1 \1, <br /> SITZ DIS?aSTTION <br /> ritiwfM` �t \r 7c_ �v r rc�. r�[ il� r� ,,� �0.1 '"twtl✓,4fl✓T <br /> E:: 22 013 (Rev.4/91) <br />