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`. SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 C(OPY, <br /> A. EMERGENCY LEVELO II III PHS-EH LOG # -07? <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: 5",�i�7 Aer si.,„ A'Aej >'_.c� /mac• Ca h - Phone: f/o .?a <br /> Company: 'S Cf—,42 a � • <br /> Address: Sup Lv /ry r OLtu-��t.��zCt) 9kYr 5,3 <br /> Designated Employee Name: r r) Phone: Usti) <br /> Reporting Agency Name: S -77-, Z c <br /> Address: wv5- ^.?, 5.; <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: isiy F, 41c-0 -5�vckAn, / <br /> (Best Physical Description) 701;y ;7r County) Circle One <br /> Date of Discharge: h � Ow 101 <br /> Date Notified: & Time: /0-4 <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: 'e-," A"44 <br /> Contact Person: Telephone: (2�1) Y66 - o 7a �9— <br /> Physical Address: z s'/v F, s C t AoLz Zz) <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: 6« <br /> Chemicals: <br /> Circumstances:_ �e.n�v«.D ;A,Ull IfvA-741 <br /> F. ACTION TAKEii`t �—i /c s u•r� P.�-t u��, �-�. le s� �/ �v •�-� - <br /> SUE DISPOSITION <br /> h 6�D f e C,(i„ /Jl__/r7 n .Tr•utc'1!:^'+ /i S 4 os G.i/�•rC� h Q/J/�'a/l.�r Gt-� <br /> oa .� v 4F rt r�► - G �7 <br /> , <br /> EH 22 013 (Rev.4/91) <br />