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A. <br />LA <br />C. <br />III <br />0 SAN JOAQUIN COUNTY 4 <br />NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br />HEALTH & SAFETY CODE 25180.7 FILE <br />Copy' <br />EMERGENCY LEVEL: I II III PHS -EH LOG # 0)-059 <br />(Circle One) <br />SOURCE OF INFORMATION <br />Name:_ .8vA4 z-- V c-� L <br />Phone: (_) <br />Company: JIQ X;t LnAr L. <br />Address: a-7 1 y f Com_ - i2 -A 5, �`�. ��-c�_ 1UcP%a -�► <br />Designated Employee Name: Phone: ( U ) <br />Reporting Agency Name: <br />Address: <br />LOCATION AND DATE OF DIS,CHARGE <br />Location: I n Ltd, <br />(Best Physical Description) <br />Date of Discharge: I" Ln ayi r\ <br />Date Notified: 'X 13-4. a Time: 1 <br />RESPONSIBLE PE] <br />Name of Business: <br />Contact Person: _ <br />Physical Address: <br />Mailing Address: _ <br />USINESS <br />C._C7 <br />4 <br />ity or County) Circle One <br />Telephone: i S <br />E. DESCRIPTION <br />Type of Discharge: e� <br />Volume: (Aby I"vj r� <br />Chemicals: &-S <br />r;rr/�i,mctnnrPc- K P i) i e -a) 54t ( -So if Y -Ai 4-- -L <br />MMMR1 <br />F. ACTION TAKEN �_n l r6 -rte a 0 e <br />EH 22 013 (Rev.4/91) <br />