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1 <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHAR <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL.--J) II III PHS-EH LOG # ! ` <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Phone: (_) <br /> Company: <br /> Address: <br /> Designated Employee Name: Phone: (_) <br /> Reporting Agency Name:_ �a,4o0, COcs�Jt�( ► ,h -tt-I—L4 <br /> Address: z�04 E. ,J � 5•r0c,eXrt--1 CO, <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location:-2--101 A.4A,fzav- L-N / s� <br /> (Best Physical Description) i or County) Circle One <br /> Date of Discharge: _ L0•Z3•4S <br /> Date Notified: {v-a Time:— I Arn <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: U&/Dyk-L k:�50 4, <br /> Contact Person: __ PDu1 nx, Qp<LAn Telephone: Sto <br /> Physical Address: 2�'D � �„� �L.a� 5� 40o 5^A/ z C� c�•{5�,, <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: Uyt*-, A) <br /> Chemicals: _ _ tb, t t3 e L 2 &6A(S .6.Ck- <br /> Circumstances: tt&haM a,(., E&UL f rH� >v pja�un tZ Z�,t3&L 7),,ztAe LM <br /> -45J%4 I �AS/'r1 E w P tiJ -rrw IC- u3rklLa <br /> F. ACTION TAKEN <br /> SITE DISPOSITION /W,4G6j AJ< L�2 <br /> Pt-40aso(1na-� r,�.S„-c�,l�- /"ct�C"i Uig <br /> EH 22 013 (Rev.4/91) <br />