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SAN JOAQUIN COUNTY [Dy <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE Coo P <br /> HEALTH & SAFETY CODE 25180.7 i <br /> A. EMERGENCY LEVEL• I I III PHS-EH LOG # <br /> (C' cle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Phone: L� ' <br /> Company: <br /> Address: <br /> Designated Employee Name: r'LfA, Phone: �) 6 8- 3 <br /> Reporting Agency Name: Scan lug R u rh Czu.,,, Pu��'i c. �-P �y,, Fns l-a-t ly. <br /> Address: N v-, o 5t- s-� sr� C19 S zo <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location:901 ZMc L )ri ecvev- -- &Arn S C M, <br /> (Best Physical Description) (City o(!ounty Circle One <br /> Date of Discharge: O 1c.r 17 q9L/ <br /> Date Notified: c..-6 6e r- l 'T W Time: �' O <br /> 3 v, rr, . <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: VLk f , <br /> Contact Person. Telephone: ( <br /> <br /> Physical Address: <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: j <br /> Volume: 1/l k-+�1 �r e ►^.a� o a�, <br /> Chemicals: 'i <br /> Circumstances: Vhcr Tl1ri P aY1S ffl le b aa - <br /> F. ACTION TAKEN -OCL & SC, UWqf— <br /> SITE STATUS 0 nukp NQdtfed- ,> u <br /> EH 22 013 (Rev-4/91) <br />