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UNTY <br /> SAN JOAQUIN CO <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> b) <br /> HEALTH & SAFETY CODE 25180.7 <br /> MERtUENCY LEVEL: II III PHS-EH LOG # <br /> ( ircle One) <br /> B. SOURCE OF INFORMATION Phone: ( ) VON `f°°Z <br /> Lk7v-m <br /> Company: <br /> Address:- ! o,,, 1' <br /> Designated Employee Name: Phone: <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> 2, W at. sio c4et-01- <br /> Location:— <br /> (Best Physical Description Y (City or County) Circle One <br /> Date of Discharge: I I wq <br /> Date Notified: to N Time:—'?'OOA,"A <br /> D. RESPONSIBLE PERS)QN/BUS NES <br /> -,� 4 2 PAA>8� <br /> Name of Business. 0 , - r Telephone: Uv <br /> Contact Person: -a S+6 6 <br /> Physical Address: D-S 2-to - L�J—, LL)a S 6 i <br /> Mailing Address:E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: -0.v G160130 <br /> Chemicals: "H2'50�1 <br /> Circumstances: 111411,w 1,262 10:� <br /> F. ACTION TAKEN;A-Q jbP-nA4 AOCQ� <br /> SITE STATUS <br /> /z) <br /> EH 22 013 (Rev.4/91) <br />