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SAN JOAQUIN COUNTY �.J COPY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: O [I III PHS-EH LOG <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: ,S!jj Phone: C2n �525�8�F3 <br /> Company: I�2, Pl r4r co <br /> Address: O 1 Md,i fin.A 0 Pank (fir t re 1 I h �Yrcr� <br /> Designated Employee Name: Phone: L� <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 400 1 Arl 4 PAA k ri u-e / <br /> (Best Physical Description) ty or County) Circle One <br /> �� <br /> Date of Discharge: (/-:�10S- <br /> Date Notified: V1,3lg5— Time: `h3y�m <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: Ind • Flec-ennlcs <br /> Contact Person: Fi' , f rrco _ Telephone: (2rFi)g2s- V-435-- <br /> Physical Address: -ito L- . •• Wit;. : n LAX, 17.r��M e c� CP— 9 533(, <br /> Mailing Address: 9 4 A: o <br /> E. DESCRIPTION <br /> Type of Discharge: C 4 'ea „ TELIz au U� bL-ki J �,n alas a te.., i.J/i (1 1 <br /> Volume: <br /> Chemicals: Orr(-; cl i, M2-,,- On load <br /> Circumstances: 4 .pLdm.•, �oii_ nLQ._ . . .n _5� .. t/I r nea a . �T d �✓ r�_4 <br /> �,Q7�1PJ J•tf9n nt �n..O Sal,c.� �i:LC..yin BiYnsit...,%,a_ �D�•7- AI"7/O6/1 G,(Je / 7D AJ, <br /> F. ACTION TAKENy% 1 Efin �h,rmn 4- .oii iAid i�- t a4Au Pj1 n-ft,en� ",?d <br /> at L _ fham 4n V,2 71A[/.Y <br /> SITE STATUS <br /> aD!. <br /> EH 22 013 (Rev.4/91) <br />