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SAN JOAQUIN COUNTY Yo <br /> NOTIF1CA7110N OF HAZARDOUS WASTE DISCHARGE <br /> FaLTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: ri 'III CH EH LOG <br /> ( cle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Lpr v Phone: V) 357—70-7/ <br /> Company: M o-n \/(fi <br /> Address: t--, 10-+'— tr i 5376 <br /> Designated Employee Name: r4 ,jPhone: (Zai)Wt--3y7,0 <br /> Reporting Agency Name: 5fW �. <br /> Address: D , o -moq , Sia r6-1., 75 o _. <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 6 0 D. .k� ST - - / C.,� °15376 <br /> (Best Physical Des=iptian) (City orCounty) Circle One <br /> Date of Discharge: U ,%uwM <br /> Date Notified: 2-3_q 2. Time: S:o fo^ <br /> D. RESPONSIBLE PERSON/BUSitirr SS <br /> Name of Business: M -s- i V <br /> Contact Person: ?- M Telephone: <br /> Physical Address: 6 d %-r <br /> -s -� <br /> Mailing Address: f35 <br /> E. DESCRIPTION <br /> Type of Discharge: ... <br /> Volume: 014k<"WH <br /> Chemicals: o I e"...►.. ro GA R b o r�5 <br /> Circumstances: `Foo U, (;-, S s ch�,r ram,.,, o v e a---•C 5 a;1 S a n. <br /> F. ACTION TAKEN w sa C,� res t, vim. <br /> G✓a3 a�..-.0 � Z s 4 � <br /> D <br /> SITE DISPOSITION 55C41 G b� <br /> EH 22 013 (Rev.4/91) <br /> i <br />