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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE I� <br /> HEALTH & SAFETY CODE 25180.u- ` <br /> ' r <br /> u <br /> A. EMERGENCY LEVEL 11 III PHS-EH LOG # q / - DO q <br /> ircle One) <br /> B. SOURCE OF INFORMATION <br /> Name: j�o b Phone: C:�S <br /> Company: c l .C' <br /> Address: t 9 -yf\ar'r ► ne, l�`�t-t�c, �-ate• Gf`1- q O'-7 <br /> Designated Employee Name: Phone: �) <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 62A <br /> (Best Physical Descnrtion) (City or oun • Circle One <br /> Date of Discharge: ( 1 +��4--YL O 1-\ <br /> Date Notified: Time: -3 36P� <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: I <br /> Contact Person: rl'hnriu.e_( Telephone: Q_-9. NgIG,-2--61379' <br /> Physical Address: 0 SDu-`I-�n �G�-v`�dl o�� `n C-i4 cl ��b <br /> q-'20 <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: _UA h .<:►'l <br /> Volume: a�-4m or) <br /> Chemicals: 1 ec-,e, <br /> Circumstances: ^^ ; �4gyt r\ ce k c-,t v- J, r- <br /> -�a vo `.r c --h- . <br /> F. ACTION TAKEN IyiA2✓Ci Mu t4 fi'�c�•f?.c qlc �t k" �VKZ-U"d <br /> SITE STATUS MLJ r4 i �`► kv-ESL L <br /> Q�Fs [4 <br /> EH 22 013 (Rev.4/91) <br />