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P <br /> SAN JOAUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> 0 1 -00 2 <br /> A. EMERGENCY L L: 4 II III PHS- LOG :2 <br /> Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: 1 s Phone: L1 :2C2e) ,( <br /> Company: <br /> Address: o tZ 2:2 <br /> Designated Employee Name: Phone: <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE - <br /> Locatiow. at)Q 'Sp+-W gj;� ! A-IN <br /> (Best Physical Description) (City orounty�Circle One <br /> Date of Discharge: �-n-� <br /> Date Notified: 2-?- :Z Time: 11 00arv, <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: v) laa 0 U Lo u n - ` e L <br /> Contact Person ee Telephone: ZP Y&Y- <br /> Physical Address: I. G ,� ^e tL�r. 7�' LO <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: r\kj. 2 M42v"1 <br /> Volume: v-� <br /> Chemicals: i e- <br /> Circ tances: <br /> 4-C- <br /> F. ACTION TAKEN, 1 Q w kLc, n C-e- P iyA u2i I t , cern oLL4�T 7 � <br /> SITE DISPOSITION <br /> r <br /> --- �".�5�-e-�smaaL cif - L e.,a� i S w A CS sY <br /> _a r <br /> EH 22 013 (Rev.4/91) <br />