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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I 1:I I1I PHS-EH LOG _.._,, <br /> (C�rcie One) <br /> B. SOURCE OF INFORIIIATION <br /> Name: Phone: Z-3 <br /> Company- o a>' a r 4A k 4;rs 14 c - <br /> Address: If zs ,'d. a.(&A j. _ ill Vey S vrbG k� C�• `�SSS-I <br /> Designated Employee Name: C legnar Phone: (ze?) 6 -033 <br /> Reporting Agency Name: S R� �04A Cm. P <br /> Address: 11'- �lJ. <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: Z--•o ©g lc c g <br /> (Best Physical Description) r County) Circle One <br /> Date of Discharge: L..f �naQ✓� �_ _„ _„ <br /> Date Notified: f/7— Z Time: .. . <br /> D. RESPONSIBLE PERSON/BUSIN SS <br /> Name of Business: '�. V-1 x,1 c9 0,4r <br /> Contact Person: 1xP,.0d 5\Tn, Telephone: -L22 9 - su Y6 2- <br /> Physical <br /> Physical Address: - _ .toot Corr i _5L. P?4o 4cr4 f C'� _ S'5 3 31 <br /> Mailing Address: -- •-- 220-21e- <br /> E. DESCRIPTION <br /> Type of Discharge: /,/�a v�-AO4 r- e essc . .. . _a U Cr�/ovYrae �K <br /> Volume: %I k,n ova <br /> Chemicals: w r .G tX le4 a s ,r e <br /> Circumstances: a I /L-/�IOtI•�' <br /> F. ACTION TAKEN v �� 1m," e �/ /�T .✓ s <br /> v ly Z L, l r�i S o r o.e a S►'a <br /> d A e - v -6rrr <br /> SITE DISPOSITION r <br /> r � � <br /> EH 22 013 (Rev.4/91) <br />