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FR <br />L" <br />" <br />t <br />• <br />�-1 <br />SAN JOAQUIN COUNTY <br />NOTIFICATION OF HAZARDOUS WASTE DISCHARGE Py <br />HEALTH & SAFETY CODE 25180.7 O <br />EMERGENCY LEVEL:I II III <br />( ircle One) <br />SOURCE OF INFORMATION <br />Name: 7• br ► q no n i <br />PHS -EH LOG # J 7 -2-1— <br />Phone:3( LI) j�W -571�O9 <br />Company: ftKM ►-IrodAtx t s L- <br />Address: P.0 • Sox (o0 38 , Ar, esc&. GA 90-7o 2 -6638 <br />Designated Employee Name: Phone: <br />Reporting Agency Name: <br />Address: <br />LOCATION AND DATE OF <br />Location: 29 Dg 114- <br />(Best <br />14- <br />(Best Physical Description) .j <br />Date of Discharge: <br />Date Notified: 6-13-9q <br />RESPONSIBLE PERSON/BUSINESS <br />Name of Business: /-W .) 4' <br />Contact Person: _ <br />Physical Address: <br />Mailing Address: <br />/ 157�CA-- /7e, <br />City r County) Circle One <br />Time: /o:O°,t� <br />�('�S'�'<g�iZ�'/J <br />E. DESCRIPTION r <br />Type of Discharge: �r1 ve6m d t5n �5p 11 <br />Volume: 2 c a., -,-s - <br />Chemicals: a5dli <br />n- _ _,_. _- i_ _1-4_/ //2✓� G ra�,�l /LHwO nF UL�.L li�fi� <br />F. ACTION TAKEN 5 ztf denim <br />EH 22 013 (Rev.4/91) <br />