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SAN JOAQULN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARFILE <br /> COPY <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: 11 III PHS-EH LOG;4 ?q l � ' <br /> (Circle one) <br /> B. SOURCE OF INFORMATION <br /> Name: GARY NdLO 60A.) Phone: (z j Al- IOP-6 <br /> Company AwAN( 2r C-i►%0FNJttzo&,)wtEN'tAL <br /> Address: Boos' N. WILSoEO W)DtX 5TtXJL M&_) C/a�- !UZ05 <br /> 5 <br /> Designated Employee Name: Phone: <br /> Deporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: H 10 o 5e?%t 110 AJE. <br /> (Best Physical Description) Ci or County) Circle one <br /> Date of Discharge: W <br /> CD <br /> Date Notified: -g °I Time: ly 1 S o <br /> D. RESPONSIBLE PERSONBUSINESS <br /> Name of Business: <br /> Contact Person: Dotnk,��S w P-t r1 _Phone�zozr�°e )q�{6- S'J6� <br /> Phvsical Address: 1640 C jo56 k1•i-t'✓ AVE- MANTECA <br /> Mailing Address: Po go 4 20 to}(0 S'zof <br /> c(o vW%vry SAFe DC Pb5cT 13ANK• <br /> E. DESCRIPTION <br /> Type of Discharge: LGAy, <br /> Volume: VQIL, <br /> Chemicals: ?e rLa t._ai7AN !i�[D1�L�(•.��Y.�c9iJ� - <br /> circumstances: «e ► >� ME- REPORT' Of f 5atL 6oR 4X_A_6DN � 2f <br /> v <br /> of AN P.N�+f2��VWlEn7ri4L ASSE'�dU/�n�T <br /> F. ACTION TAKEN I GAK Flo /r 14YORAIAL C 0-1 L►F7 t- i� <br /> S,6R\]1G_RASk A r7E CAP- D _,-A L.Er2ZdLF. e Ed_QwSW »tFYTO Sl.55,0612() <br /> eI <br /> SITE DISPOSITION S me Ar,)c:�jen TO Ce11VTAMASi `"r`''te SfT" t6m5j= r45 <br /> F=tArZ-C A'�--7 -,-, 1 1 LC7 �Yil; ':�'- ;2 �'n1�4'riOA) MAY 35ZR Ru fz <br /> TV CLWQCf�i NO.v TAlVILSt <br /> EH 22 013 (Rev. 08/20/99) <br />