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n, SAN JOAQUIN C UNTY <br /> NOTIr,,ATION OF HAZARDOU 3 WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVELII III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMA?'90N <br /> Name: Lyknj LOd Phone: Wj X23 Rt5' <br /> Company: Mnbolte J�cVr - 1.Q yrt' <br /> Address <br /> Designated Employee Name: Phone: L� <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCWGE <br /> Location: E- �d5ew1( / <br /> (Best Physical Description) 'ty r County) Circle One <br /> Date of Discharge: rl <br /> Date Notified: 1. 13•R3 T' e: Q=Dd <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: C)e1+-05 e ee� vI�as1� <br /> Contact Person: LOO Telephone: <br /> Physical Address: -+ ff 1c6e-r--(4C �� C/4- of sa ; <br /> Mailing Address: t 44 Li t Su+t ti C 4532 <br /> E. DESCRIPTION <br /> Type of Discharge: Po fryt-c-iwi 1::o� `�GA Prey-stcnTe5�- ,I eak <br /> Volume: l) ��w <br /> Chemicals: - a5 <br /> Circumstances: tw resut+s o a I lc <br /> L+.u <br /> F. ACTION TAKEN �c crn r� t r2� un <br /> SITE DIS OSI ON pv-Q�;d�. -Tky- SDE (, a <br /> onw� <br /> l vtu�s�-t G-lZ o-� a W ( reAv4r , <br /> v h/ <br /> EH 22 013 (Rev.4/91) <br />