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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE `,. <br /> HEALTH & SAFETY CODE 25180.7 <br /> U <br /> A. EMERGENCY LEVEL( II III PHS-EH LOG # 93- <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> _ Phone: <br /> Name. (_) <br /> Company: <br /> Address: <br /> Designated Employee Name Ae A' ' Phone: <br /> Reporting Agency Name: Ce, 41,L-4 <br /> Address• 1i ,'4 - <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: i-1 �1 Yo Sem 1�-- � ''� <br /> (Best Physical Description) �Citor County) Circle One <br /> Date of Discharge: 2-?s —s 2 <br /> Date Notified: i- 4�-S'3 Time: 3 <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: A 4-C C) <br /> Contact Person: t /� 4 A Telephone: (� aZ <br /> Physical Address: Ye sem%4c- V14 C..1 e-, <br /> Mailing Address: �, 5 S �?� kcF ;Z C«r;�� �g 9©jai <br /> E. DESCRIPTION / <br /> Type of Discharge: 2 e-a/i;x � �. / �i i�4 c,.�4'��' f-�>c Wil%`; •ay. <br /> Volume: 2 S--4 S//a•�� - <br /> Chemicals: so%�► <br /> Circumstances: v5-6mei ,7v4ce c 4s y ��•*s r;o� <br /> F. ACTION TAKEN %Li ;.3 as <br /> !is <br /> //b rhe✓ �L �' ' � r✓a ,-4 oG �✓ ' �'--,.� <br /> a�So�.�// .�- r%!c S✓i�/ was �s..rr/•rte•~ r4� •�,�- <br /> /'iMf//Y�" <br /> SITE DISPOSITION <br /> EH 22 013 (Rev.4/91) <br />