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SAN JOAQUpi COUNTY ' ME COPY ' <br /> NOTIFICATION OF HAZARDOUS:WASTE DISC <br /> HEALTH & SAFETY CODE 25180.7 - -- <br /> A. EMERGENCY LEVEL-0 II III r PHS-EH LOG <br /> (Circle one) <br /> r <br /> B. SOURCE OF INFORMATION <br /> Q Phone: {�°�j' <br /> Name: Gl�,r� r1l �.c� I v��v�+ w ke <br /> Company: d Ch C, 2 t' <br /> Address: vM � Phone: &,-7ub <br /> Designated Employee Name: 4��^ <br /> Reporting Agency Name: <br /> Address: D <br /> C. LOCATION AND DATE ;OF DISCHARGE_ - <br /> 1 � 3 5�+w tzb . � <br /> Location: Ci • or County) Circle one ' <br /> (Best Physical Description) <br /> w� <br /> Date of DischTime: 0 % 6 ►"� j <br /> Date Notified: u o <br /> E: <br /> D- RESPONSIBLE PERSONBUSINESS ' <br /> N;t VL�a� <br /> Name of Business: dGl Phon ' DSI <br /> � �6 <br /> Contact Person: l/ d t O <br /> Phvsical Address: i^'�''�" ` <br /> Mailing Address: <br /> E .. <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> (��b o( i mac. D, <br /> Volume: Lf-IL O---, W !!I dGe, ai''l rv` S <br /> Chemicals: <br /> Circumstances: 4N c f <br /> F. ACTION TAKEN a <br /> I <br /> Bim <br /> SITE DISPOSITION S�7 i ` SSG ` • "~ <br /> A1C C f i� •�}- - k <br /> 5 <br /> r. <br /> ii <br /> r <br /> ER 22 013 (Rev. 08120198) <br />