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SAN JOAQUIN COUNTY <br /> NOTIFI(!-,TION OF HAZARDOUS WASTE DIz!�HARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:aII III PHS-EH LOG <br /> (Circle One) <br /> P. SOURCE OF INFORMiATION <br /> Name: 443 0 Jo;G r &J,1-TVA S Les Phone: Cio 1�2•. <br /> Company:45 t. fa.,� <br /> Address: 5"0 94 a r- :t 3 /o Nv <br /> Designated Employee Name: Phone: <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHAR E <br /> Location: 76 JIF Aoftlf,%c. W� 7bN <br /> (Best Physical Descript}'9n) i or County) Circle One <br /> Date of Discharge: 0N01/ <br /> Date Notified: -7- 50, 91 Time: "d D qn^ <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: nvt "y &4 1j9P*1P1,Z <br /> Contact Person: _ &' -&A 1S'.�►ito Telephone: <br /> Physical Address: <br /> Mailing Address: _ /Ooop !�¢,C�woo _ 'G1 t E� .4 POLY0 <br /> de <br /> E. DESCRIPTION <br /> Type of Discharge: UVAyr6e+erted Aer-�e' <br /> Volume: yN K <br /> Chemicals: dls o a,u E <br /> Circumstances: r-A& ,rlfate.�-s ole' $er r til*rvz+t it eff <br /> So,4. ba a r,Ni s A0AJiT's0drNs we u5 <br /> 17. ACTION TLXKEN <br /> •S T. .., se`n r ?fit <br /> + • <br /> ce <br /> SITE DISPOSITION <br /> A: P. " <br /> 1 [1 2'2 013 (Rev.4/91) <br />