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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A.. EMERGENCY LEVEI II III PHS-EH LOG # <br /> cle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Phone: L� <br /> Company: <br /> Address: <br /> Designated Employee Name: Phone: <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE L^ <br /> Location: 1y'g00 V.1 " 17- <br /> (BestPhysical Description) (City oroun Circle One <br /> Date of Discharge: <br /> Date Notified: -4• Time: I2:100 QM <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: rTou..tc v- A96-;-K <br /> Contact Person: v0 nj. ctbee- Telephone: (_) <br /> Physical Address: tLkgc.c W ItN�j LZ L-9cb CA g5Zz-10 <br /> Mailing Address: -2 <br /> E. DESCRIPTION <br /> Type of Discharge: S P s l <br /> Volume: _ UN-",Mw 0 <br /> Chemicals: a L L el <br /> Circumstances: D Os^ 's,01 77 <br /> F. ACTION TAKEN FI hl dyozv-b:aYLS tntft LI -IrvUL d <br /> tu4S l cvwc <br /> &ovd i a o ti <br /> SITE STATUS `LC v5 I1C.C.4-0,A C Oo'YI GD f rL <br /> l L <br /> atg <br /> f <br /> EH 22 013 (Rev-4/91) <br />