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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CO E 25180.7 <br /> C rn [L )Y( <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG # ant? <br /> ( xrcle One) <br /> B. SOURCE OF INFORMATION <br /> Name: 5 7-V/✓ Phone: �0) • Z3/ <br /> Company: /N <br /> Address: 12 � CAW" U � .o►� <br /> Designated Employee Name: Phone: L_ ) <br /> Reporting Agency Name: <br /> Address: f <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: / 6 oSEiT� / <br /> ' (Best Physical Description) City r County) Circle One <br /> Date of Discharge: —OAAlOuJN <br /> Date Notified: !" /(v -1 Tim 4Oo <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: zz"d&X-170sed Ao <br /> Contact Person: Es Telephone: (c '- <br /> Physical Address: :70 0 <br /> Mailing Address: ZoOC] Cc-6�c-1 .10-9/00 100p � 6L4�1 <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: k <br /> Chemicals: o -,j <br /> Circ mstances: So/c. eat <br /> S jcSS' <br /> F. ACTION TAKEN — <br /> r f <br /> U c1� <br /> �.Gcet <br /> SITE STATUS <br /> jig- <br /> f <br /> ' I <br /> EH 22 013 (Rev.4/91) <br /> I <br />