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« SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:0II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: 133(LU.a Phone: 944-c4� <br /> Company: XAL <br /> Address: /Z c�. _6c <br /> Designated E 4 ployee Nz e: E cst76 Phone: <br /> Reporting Agency Name: I + r-' PU1L2cul vi r - r <br /> Address: 446 �J, 1&7- <br /> C. <br /> TC. LOCATION AND DATE OF DISCHARGE <br /> Location: 4KR i, �b`t' ISyfi vD - J. Lb&q.I-r <br /> (Best Physical Description) i r County) Circle One <br /> Date of Discharge: (n <br /> Date Notified: �P,y 2 5,l 9C)1 Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: \\ o L r N �d u �.► ,Kr� <br /> Contact Pe n' <br /> Telephone. )�14�- xct, <br /> Physical Address: <br /> Mailing Address: ft-L, Ki tit r <br /> E. DESCRIPTION <br /> Type of Discharge: L fkebl k c'XSL 7+e&6, Ff2&M A% <br /> Volume: A?9Urk- I lC� C-Iit �s <br /> Chemicals: l SCD <br /> Circumstances: U,QW,)etno JIOSsI6LC S�ST�-YV� i—,A-tui►2� <br /> F. ACTION TAKEN -Tb4 tJ k CID► T5Yt PTI C�� . <br /> SITE DISPOSITIOiN1 �,�JhS �l I(,ice <br /> _�N l�- �D Qkt.►l'i'C-'t� (�`n}y1�,+►�r1't� S-�.t_ <br /> EH 22 013 (Rev.4/91) Fly <br />