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SAN JOAQUiN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> I �1 <br /> A. EMERGENCY LEVEL: II III PHS-EH LOG M "D�o� <br /> (Circle One) <br /> f B. SOURCE OF INFORMATION Q-o.,-A v -r_ I <br /> Name:1 � � E3 Phone:Company: <br /> Address: <br /> j Designated Employee Name: Phone: (�) . y <br /> Reporting Agency Names' S-.� Tia.E, •• K 1,1 c �, c.k-, Cn.,u.L <br /> Address: SNS iJ. Sr•.. JOGctii+ �T S�{Oc. jc�r+ ri0 9s �tCf_ _�ri_�[•uj <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: /-Ln(/ F, iY�arn <br /> ;J{ (Best Physical Description) Ci o County)Circle One <br /> t Date of Discharge: �•N •���� - <br /> Date Notified: Time: Ao •�-� — <br /> R D. . RESPONSIBLE,PERSON/BUSINESS / � a <br /> Name.of Business: 4 c m:G a` /n c%.s�r ec r0 -S�;L'�°y� y <br /> Contact Person:_,. TvhH °�� t ce-0c Telephoner( 9y6-(a.7 JA_ `" } <br /> ,RPh cal Address: _ ✓�l7 s/ :�: rrt G/H�.��5�c-/c�aM_ C4 <br /> Maltingdt(i�• sr 3 Y <br /> � e�'tt rW V v� L n, Slve�' r/vt dl 9S`Zf!'��- •. , <br /> '_'v a tti 9 <br /> E. DESCRIPTION <br /> Type of•Discharge: Len G'u •car/u }F <br /> Volume: <br /> �. Chemicals: ' - n, <br /> j Crrcurnstances: f <br /> o <br /> n - <br /> "1 <br /> F. ACTION TAKEN n v�ic'o " Cu/ w '••`'V <br /> r � i S ` rr`o i tJ ,y <br /> a <br /> /!w S. I GSITE DISPOSITIONr 0 S,&4v <br /> '�D'A�e� :�r�oL► .r ty w' ' <br /> EH 22 013 (Rev.4/91) <br /> e . <br />