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O �.• SAN JOAQUIN COUNTY <br /> D O NOTIFICATION OF HAZARDOUS WASTE bhCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:OI II III EH LOG # O,- -- aQ <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: P h&se-JE S;+c AsSess mevtt" Reeoe t 06 Al�j goo z Phone: ag <br /> Company: Af uamceO Gco GtAutrovlme'tt-o-, 1 M� <br /> Address: F37 Shy -ck <br /> Designated Employee Name: Phone: <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 3978 S, r �� 9V —,Ss/ F��K SfdU���`` <br /> (Best Physical escnption) (City or ounty Circle One <br /> Date of Discharge: oh Kneu)rl <br /> Date Notified: 25 JZN G 'LOU Z Time: 2= 3 w--- <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: <br /> Contact Person: Rfl ft 3) I SAMy 'ZA Y74cou 6 Telephone: 20 �Z8- 975 <br /> Physical Address: 3979 s ,o 4iva <br /> Mailing Address: 397e 5' 9 T99 C4 95Zo5 <br /> E. DESCRIPTION <br /> Type of Discharge: Leak- <br /> Volume: Uv, ,-vk <br /> Chemicals: ��1 <br /> Circumstances: 'deo,c�v P (esv f fs oQ so,c fe s fr,� �owr list f s �c �lca t <br /> F. ACTION TAKEN ,� rcce i c Dve�s+ �dCoav2 C,3 e <br /> Cvj &— Sol ( C�I.tfc,u�ivia'f.oj1 sa` e er ;'s �e urjtCJ <br /> SITE DISPOSITION �, �� �� /� u K �• later 6�1 c °'so;l �vk u"`y` <�`� <br /> 05T°j akd Gy.l( be 1,e9y<re r/ Av Crnn-/%hye i4Ile st y4t;` a1 Vo d2Aevey►<h< <br /> e�xfep f- &4,-d aA,,5 of f—y-e a.,,d ta <br /> e-,t+etiV1L-i,ye5 <br /> EH 22 013 (Rev.4/91) <br />