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�.I <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:(D II III PHS-EH LOG# <br /> (Circle one) <br /> B. SOURCE OF INFORMATION <br /> Name: 2" Phone: (w') <br /> Company: 06 t D S <br /> Address! 9,1141 , c] e,r o� <br /> Designated Employee Name: Phone: <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location:-- -e—oSemt e 1 ` .C� <br /> (Best Physical D r-iption) ity r County) Circle one <br /> Date of Discharge: cu <br /> Date Notified: 161 Time: !Dd otter-. <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: C DM m e s ve., -�.,� `� lCcr�5 a 5 <br /> Contact Person: Phone: <br /> Physical Address: <br /> Mailing Address: p 1 <br /> E. DESCRIPTION <br /> Type of Discharge-._ Le,JC <br /> Volume: ;- <br /> Chemicals: n -e- _ <br /> Circumstances:. arn,I nJ&,'0-+0-r Set'vW(c Ce-SU <br /> F. ACTION TAKEN I A 5-11 'S d Q <br /> SITE DISPOSITION 5 c`f e a � vclerSl `i-( <br /> o a � <br /> a r <br /> aK rr e rw� dna (ef t <br /> D <br /> ,1p o� <br /> EK 22 013 (Rey. 08120198) <br />