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SAN JOAQUIN COUNTY <br />NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br />HEALTH & SAFETY CODE 25180.7 <br />C 0 P <br />EMERGENCY LEVEL. II III <br />cle One) <br />PHS-EH LOG # crp, --/T 0 <br /> <br />Company: <br />Address: .2125 /5:- <br />c. . <br />B. SOURCE OF INFORMATION <br />Name: fr24.<_d <br /> <br />5Y) 5Yex-4--- CAr 9.5-2-0 5" <br />Designated Employee Name: 00 UG IV -?1b , 1`:). 6 Phone: ( <br />Reporting Agency Agency Name: <br />Address: <br />LOCATION AND DATE OF DISCHARGE /661$1 02 0 Z51(1 <br />Location: 1/(-.5 Al - ‘(./4-14044- / SYDc/e-Vrs <br />(Best Physical Description) t---ior County) Circle One <br />Date of Discharge: UNKAJoui A/ <br />Date Notified: ,444-12, .3, 2-co co Time: <br />RESPONSIBLE PERSON/BUSINESS <br />Name of Business: #/i#'4/'99 <br />Contact Person: 00.3 ,9ci.v6-/-e-C.o Telephone: (go?) Z 4777 <br />Physical Address: <br />Mailing Address: 63?3' av( <br />DESCRIPTION <br />Type of Discharge: 0Ai-/c,tas-elki <br />Volume: /),14e--.4.40.4/A./ <br />Chemicals: <br />Circumstqnces: See <br />(ifv17V <br />ACTION TAKEN - 94 <br />SITE DISPOSITION <br />Phone: (2ot WE-. /3q5 <br />EH 22 013 (Rev.4/91)