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0 <br />C. <br />SAN JOAQUIN COUN'T'Y <br />NOTIFICATION OF HAZARDOUS WASTE DIS%-riARGE <br />HEALTH & SAFETY CODE 25180.7 <br />EMERGENCY LEVEL: I II III <br />(Circle One) <br />SOURCE OF INFORMATION <br />Name: AoUL�'- `zi2r-,Aie <br />Company: <br />Address: Z0500 4o" - l p <br />Designated Employee Name: <br />Reporting Agen Name:_ <br />Address: <br />PHS -EH LOG # <br />C13-O2� <br />�/one: L� qS - 3Zta <br />LOCATION AND DATE OF DISCHARGE <br />Location: Z ?400 <br />(Best Physical Descri tion) <br />Date of Discharge: 6',h- <br />Phone: (, ) <br />Date Notified: 2 Time: �I70a w� <br />Cgj_ r County) Circle One <br />D. RESPONSIBLE PERSON/BUSINESS <br />Name of Business: /fib r' rJ-64ICoepo�•0%2'0� 1 <br />Contact Person: E' 5 f E�iTelephone: (E�2) S7 35- 301D <br />Physical Address: Zasoo / �2, ' 4 953 7g- <br />Mailing Address: o i3xo x 60 <br />E. DESCRIPTION <br />Type of Discharge: �Z <br />Volume: <br />Chemicals: 01Z - <br />Circumstances: <br />F. ACTION TARN <br />Z -1A E' L-,414: <br />/Ji���v�lC'��i� its' •ter �i�� ,�'.�i <br />SITE DISPOSITION A <br />7i�,2��i'�� ��J � 2 iG /� S�i�L/,1GZ �%` ,t'r.�.-�-+�',✓;�/fiT'�o�', <br />/4-AJ4t'�/ <br />EH 22 013 (Rev.4/91) <br />