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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISC E Cu <br /> P Y <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVELEVEL III III PHS-EH LOG T / V <br /> ele one) <br /> B. SOURCE OF INFO R__NIATION <br /> Name:_ Fc�ej Phone: (clIb) 3-41-b `I ?y <br /> Company C i �A. .t <br /> Address: �t�lr Pctic� � Yz, I �uf fLlPS� c E'c�etlPe.,�n <br /> Designated Employee Name: Phone: <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> /AVON ASO--o20-3 <br /> Location: k -F P AC� <br /> (Best Phy icai Description) City r County) Circle one <br /> Date of Discharge: V\ . . <br /> Date Notified: he v 2 5^E 129 <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: �, i TL .EiL ilnu �CC k-,+f+nc +�;a. <br /> Contact Person: McA,uvin 1 ����� Phone: q -060 9 <br /> Physical Address: 14 S 31 c v rA us e mc- <br /> Mailing <br /> e Mailing Address: <br /> E. DESCRIPTION <br /> T-,-Pe of Discharge: l,__- <br /> Volume: 6kc> <br /> Chemicals: ;PP4,,(c, J1,,: 11! � <br /> - <br /> C ircumstances: C C^.o4- ,?A.7 <br /> en 1n -St x —(Mj ACI. <br /> F. ACTION TAKEN ,1)c, k%v.n,c� en) 5 CC �c <br /> SITE DISPOSITION <br /> EH 22 013 (Rev. 03/20/93) <br />