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SAN JOAQI-,TIN COUNTY <br />NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br />HEALTH & SAFETY CODE 25180.7 <br />EMERGENCY LEVEL: II III <br />(Circle One) <br />pHS <br />y:7 <br />P-EH LOG # qc --106(c--3 <br /> <br />SOURCE OF INFORIMI <br />Name: Ir .(-g-464-114,--1,81.-,..140--tX Phone: (&)..3V- ?? <br />Company: .•(/146,-Le <br />Address: i‘&4,71A /04)(0/i Ci•ete--1-0(-a•-•,coj <br />Designated Employee Name: Phone: ( ) <br />Reporting Agency Name: <br />Address: <br />/ <br />(Cior County) Circle One <br />C. LOCATION AND DATE OF DISCHARGE <br />Location: <br />(Best Physical Description) <br />Date of Discharge: c.vx-ic-pcs--oo—k._ <br />Date Notified: <br />RESPONSIBLE PERSOXUAINESS <br />Name of Business: Vrt--rk ,4e-tw-e-d-6-te <br />Contact Person: &9it /162-x-d-o-=,4, eChczA-x--c-LA- Telephone: ('o) F76.-zi (..F/),S)/64.17‘ <br />Physical Address: 72o <br />Mailing Address: 0-Y Y7 F <br />DESCRIPTION <br />Type of Discharge: <br />Volume: <br />Chemicals: e j(94.26 .•Sej <br />Circumstances: 4- a-Ica-Lep:4 zaZ <br />Time: <br />SITE DISPOSITION (i). ,d-r-4° • <br />61 <br />EH 22 013 (Rev.4/91)