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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: ®II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Phone: (� <br /> Company: L• L r;�s <br /> Address: Li 100 (four+ , (-�a IGe,-s-r-teCd CP <br /> Designated Employee.Name: I O z_- Phone: (2,)D q(o Er ,3V`f <br /> Com• P b �{ u (+h Sec�vrre.s E,ovt.-on•�teal:u, <br /> Reporting Agency Name: �' v,r u /r e <br /> Address: Y s-s- A-.), Sa^ �-�� S 4,,e-k C,4 9 �' <br /> C. LOCATION AND DATE OF DISCHARGE / S-�roc�l�� <br /> Location: FY eA(-h Car-10 C r,d-F,l! �/� Own���, <br /> (Best Physical Description) City r County) Circle One <br /> Date of Discharge: a o le "-z <br /> Date Notified: jL 9.3 Time: d Pm <br /> D. RESPONSIBLE PERSON/BUSINESS 3 e?f. <br /> NoS�C-l��^ eve^ <br /> Name of Business: � <br /> Contact Person: eller or S�4eo k C-A K Telephone: ( 437 e&d-6 <br /> Physical Address: vas Al, £-A ckIs, CA 7 2 7 <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: u-k tc- <br /> Chemicals: VoL +ale r NC- le•� <br /> Circumstances: Moyx�+� w� �� sar,T�' s' �d V,.L+� <br /> VoGi <br /> F. ACTION TAKEN 6)C d <br /> a <br /> SITE STATUS <br /> EH 22 013 (Rev.4/91) <br />