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OSAN JOAQUIN COUNTY <br /> NO1,1FICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 [� <br /> EMERGENCY LEW[,:o II III PHS-EH LOG # <br /> (circle One) <br /> p, SOURCE OF INFORMATION <br /> Name: MAGAG Mqr COUN"PUKJC HFTN WMICES Phone: ? Y(c51 <br /> Company: ENVIRONMENTAL,MaALTM OIVISION <br /> Address: F.CF. <br /> Designated Employes Name: Phone: (mac ) -�c Y- 3 y `t D <br /> Reporting Agency Niirtte: S�:_., - -�o.�,�:•, �1�1 � �.�.. tic-, S���c� <br /> Address: AJ S.;,, :J;-o u 4 S S";�o , f?o <br /> C. LOCATION AND DA'I,q OF DISCHARGE <br /> Location: :�, E, ��,, Gr / Azo, <br /> (Best Physical Description) City or County) Circle One <br /> Date of Discharge: — <br /> Date Notified: A; j Time: /y.4 .�-� <br /> p, RESPONSIBLE PE;2,yt)N/BUSINESS <br /> Name of Business: �c.mz Sc� v- s s"gip�y <br /> Contact Person: �� �hH ��« « Telephone: �3 s <br /> Physical Address: ,. 5A.,plc 4-m C Gg <br /> Mailing Address: �; 3 Y.;L �,�u K r 5-4'C../ <br /> E. DESCRIPTION <br /> Type of Dischar-e: Gu '4�v� u <br /> Volume: <br /> Chemicals: <br /> Circumstances: -s-, <br /> A <br /> F. ACTION TAM:N' <br /> aa /' <br /> z- <br /> , srso - ` -- <br /> SITE DISPOSITiCN',S,'- A,' 5"4e G�cs�s_ct�.o.e� ,�,�, .11ae ^,Oc a«, ear ,.>•r�w <br /> E;{ 22 013 (Rev-4/91) <br />