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fj <br /> { SAN JOAQUIN COUNTY L. <br /> a <br /> NOTIFICATION OF HAZARDOUS WASTE DIS(WGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: (J� II III PHS-EH LOG# <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> f Name: �Y ;P r)r "C �r <br /> Ph , <br /> one: <br /> Company: We;icy, r <br /> Address: _ Y3 L1 5-j Mur vn 12 <br /> Designated Employee Name: 'I Phone: U <br /> Reporting Agency Name: !i <br /> Address: <br /> ,b <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: _�. 3(a N.,, th w;Jsoh wj} T/ S to c.k f oh <br /> (Best Physical Description) I or County) Circle One <br /> Date of Discharge: ._ �i n k n,,wn ._ <br /> Date Notified:- 3 - 1-13 Time: <br /> r <br /> �Y <br /> D. RESPONSIBLE PERSON/BUSINESS I <br /> C Name of Business: R Gz�,,o:,d q;Syyct 41 ! _ <br /> Contact Person: .R a�-r»,�,:,-1 i� I S�v,-7 }-1 .. k Telephone: <br /> Physical Address: 3 N.rt w -rco _ wr �' C,�f <br /> Mailing Address: rr^31_ . n�'_, � <br /> E. DESCRIPTION <br /> Type of Discharge: e�� <br /> k Volume: <br /> C Chemicals• <br /> Circumstances: R C,f (ts pf sQt I!W es ��, o�tra,V1ea A�X Ph <br /> F. ACTION TAKEN Utr e'� �hn,k,G4 tuk)k }',-ry,rka11i Si-cgeej drsc�Wcjej <br /> ij <br /> i? <br /> E <br /> SITE DISPOSITION Us1- cr111 ir,�,at;cF, v,�]( n� !;I.,c t!,kAehtr�l w��h UAB <br /> R <br /> 0hi o��1 <br /> 4 ,� rc `r�.�., <br /> __C1�,l� r{ly1 C'r�llUfr ol, Iy�Y D!_ rr�-ttiYe�T' h.4 CI`L � �r//1L✓f�� ). <br /> i <br /> EH 22 013 (Rev.4/91) <br />