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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE. DISC'rIARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> C> CD <br /> L7O <br /> A. EMERGENCY LEVEL6 II III PHS-EH LOG # f' <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> —77)' � rid _ Phone: <br /> Name: <br /> �r�wia <br /> Company: <br /> Address: SSS' �w� �l� <br /> Phone_ <br /> Designated Employee Name: <br /> L� <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGr- <br /> Location: z'7v / l,/. f"( - or County) Circle One <br /> tion <br /> t Physical Description)CBS y� <br /> Date of Discharge: "9th <br /> Date Notified: 6 - 7-6 —g Time: AY-1 <br /> D. RESPONSIBLE PERSON/PUSINESS <br /> Name of Business: VQ c � � <br /> Telephone: ( <br /> Contac Person:- <br /> erson: �A dr, /q <br /> Physical Address: '900 9 <br /> MailingAddress: /�o 2�'v 7G �S 7 37 <br /> E. DESCR.IPTZON <br /> Type of Discharge: - <br /> Volume: ✓� <br /> Chemicals: o <br /> Circumstances: <br /> F. ACTION TAKEN <br /> SITE DISPOSITION �d-c.• d-�� a"� �^^-�^'�' . , �o. �� <br /> 1-:1-1. 22 013 (Rev-4/91) <br />