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or . x <br />0 <br />C. <br />E <br />• SAN JOAQUIN COUNTY • <br />NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br />HEALTH & SAFETY CODE 25180.7 cco)F)y <br />EMERGENCY LEVEL: (ZII III <br />(Circle One) <br />SOURCE OF INFORMATION <br />Name:_ -t�>k l ZO-Dk,O— <br />e <br />Company: - 43-1 <br />Address: rP, 0 ter <br />Designated Employee <br />Reporting Agency Na <br />Address: S©-4 <br />PHS -EH LOG # z Gz <br />Phone: C]5/, <br />) <br />LOCATION AND DATE OF DISCHARGE <br />Location: �'� i/,, l '� 1, !, ro-cyy1or rf- / <br />(Best Physical Description) <br />Date of Discharge: <br />Ci or County) Circle One <br />Date Notified: moi'-zq- f� Time: /3 /,c k)lr� <br />RESPONSIBLE PERSON/BUSINESS <br />Name of Business:' CC, <br />Contact Person: l l � Telephone: &/0 <br />Ph ' al A <br />ysicA ess. <br />Mailing Address: n 2c:x %�� sf-G.ScC� QC's -�, <br />DESCRIPTION <br />Type of Discharge: <br />Volume: t; <br />Chemicals: L <br />Circumstances: <br />F. ACTION TAKEN a C., t` <br />SITE STATUS �, 1_ -AACXAlP(i <br />EH 22 013 (Rev.4/91) <br />