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SAN JOAQUIN COUNTY <br /> NOTIFICATION <br /> UNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARG . <br /> HEALTH & SAFETY CC DE 25180.7 V <br /> A_ EMERGENCY LEVEL: II III <br /> PHS-EH LOG # v <br /> (Circle One) <br /> B. SOURCE OFIlff ORMATION <br /> Name: 157S70/U /Z- Phone: •1131/ <br /> Company: Co N <br /> Address:_ ZGi�o u> N G 4 7✓ S�3 <br /> Designated Employee Name: Phone: (_,) j <br /> Reporting Agency Name: <br /> Address: <br /> I <br /> C. LOCATION AND DATE OF ISCHARGE <br /> Location- <br /> .(Best Physical�� tion) Cir County) Circle One <br /> Date of Discharge: <br /> Date Notified: Z- T' e: :o0 't a <br /> D. RESPONSIBLE PERSON/BUSINESS `{! <br /> Name of Business: /V!D/I/ 5W <br /> Contact Person. ` Telephone: Z 3 <br /> rz <br /> Physical Address: <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: �J�lou1� <br /> Volume: <br /> Chemicals: 6401. <br /> Cir Lances: Al S'oiG SGo '� <br /> ESS .K E �s�c MIS d� <br /> F. ACTION TAKEN <br /> tL2� F <br /> 47 <br /> SITE STATUS ! _ <br /> u/ di1C. � <br /> i <br /> EH 22 013 (Rev.4/91) <br /> i <br /> j <br />