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SAN JOAQUIN COUNTY _ <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> . CD S —o eu <br /> ,EMERGENCY LEVEL: I I II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: �lJa.� ��w-� Phone: (? y81 `fooZ- <br /> Company: o .vim. <br /> Address: !Sdo C42 rw•- - <br /> Designated Employee Name: Phone: (_) <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE / Sto c,4-t-e,- <br /> Location: �S 2-6:, , CLA- <br /> (Best Physical Description (City or County) Circle One <br /> Z <br /> Date of Discharge: I !oL S- <br /> Date Notified: Time.• ?=00 A,AA <br /> D. RESPONSIBLE PERS N/BUSINESS <br /> Name of Business: D S �� �0 <br /> Contact Person: Telephone: ( ) Y6 7- 3 �Z <br /> Physical Address: • WO S f0 ^" <br /> Mailing Address: I-J• I Sf to S�o3 <br /> E. DESCRIPTION . <br /> Type of Discharge: r ... <br /> Volume: <br /> Chemicals: SO <br /> Circumstances: <br /> F. ACTION TAKEN ;A-P <br /> / J <br /> /j�Zvv7)llQ� l;�l Q� <br /> SITE STATUS <br /> EH 22 013 (Rev-4/91) <br />