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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:(1 II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: jF,,z4tyj Phone: <br /> Company: 5E)P—r/i G <br /> Address: 6 S , Lr N "L- Sr 17 1,:� <br /> Designated Employee Name: "✓A v Ph ne: <br /> Reporting Agency Name: , < <br /> S' h HeAr 7ilf - 1w- <br /> Address: <br /> Address: g a 20 o 9Gg <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: r q 6 S 5 , L�� t.i�j C44 <br /> (Best Physical Description) (City or Coun Circle One <br /> Date of Discharge: U N /< 0 w j <br /> Date Notified: 13 —`�3 Time: / <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> (a4vName of Business: F SGS 7 _ <br /> Contact Person: Telephone: <br /> Physical Address: j�6 r S, l.c rJ L-,,a 1 Q r 5�-�-dGl�r� C��1-ter� z0- <br /> Mailing Address: .S*m e--- A--5 � ��� <br /> A--5 6P i <br /> E. DESCRIPTION <br /> Type of Discharge: ()4Av--n4-6P-4LZ;eJ <br /> Volume: U NI�-►n to w L,) <br /> Chemicals: o % L <br /> Circumstance • G- v r2. iV I e- <br /> . H r, v — <br /> F. ACTION TAKEN A7 �z fe-5 Lti <br /> Ga v v, -t -k/ 4-e- <br /> SITE <br /> eSITE DISPOSITI9N 2- ec,:; /77 <br /> JA <br /> G� <br /> EH 22 013 (Rev.4/91) <br />