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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCIJIM <br /> HEALTH & SAFETY CODE 25180.7 %6 JOPY <br /> A. EMERGENCY LEVEL:©a III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: 'G�u c r. � �S ac, 23 /lt'� Phone: 9(2-5 2 5-1650 <br /> Company: Ait15,-, eA <br /> mess: <br /> Designated Employee Name: 7V Phone: C__) <br /> �= Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DA'L'E OF DISCHARGE <br /> Location: Ieei500 5. lAfre-ie$7*,rE <br /> (Best Physical Description) City r County) Circle One <br /> Date of Discharge: 0,VXVoyJV <br /> Date Notified: 7-3/-18 Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: lk<c 2eA16 �i¢rry <br /> Contact Person: 04416 e-AFNIGLE Telephone: (15i02 Zli'• 2335 <br /> Physical Address: AX)0 CROcJ G /yo v A- 5�1160 <br /> Mailing Address: A4--e <br /> E. DESCRIPTION <br /> Type of Discharge: `^ <br /> Volume: ���-k--o ►� <br /> Chemicals: 773 <br /> Circumstances: �'Rdw.citJ Le.i/ EirJT o�U 5 1p�' <br /> e 167, Iu <br /> F. ACTION TAKEN <br /> SJ7N G !1S N r av =,e..z aft E 4Jlc e- <br /> / UDE� �PS G�/•yE�2s�ia - <br /> - f CV4wO C3 ort <br /> 007evEc Nom? <br /> SITE STATfJS <br /> N4W 5tTZ7 4M,1A1E;-W- 7TSG® Ab4/ fy-65r) /1'-4 <br /> our �J,vAE Z4242C <br /> U5 7- . <br /> A14-Ute- <br /> EH 22 013 (Rev.4/91) <br />