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SAN JOAQUIN COUNTY' <br /> jNOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> = HEALTH & SAFETY CODE 25'180.7 <br /> s A. EMERGENCY LEVEL: 'II III �.�. ++ ~': ;-_PHS-EH LOG # 9-2 <br /> (Circle One) w i <br /> B. SOURCE OF INFORMA'T'ION <br />' <br /> Name: `✓ /�Si r'/z� i Phone:. <br />+, Company: <br /> Address: 2 r 5 5 Cz>/JAl_-' <br /> Designated Employee Name:_ IaGi l A- I' _•_ Phone: <br /> Reporting Agenc Name: II <br /> Address: utf ,� Sr4 r�L �v �.�1 II7t-,�;'�nl e' <br /> i C. LOCATION AND DATE OF DISCHARGE <br /> Location: � ALA4 22 <br /> (Best Physical Description) j er)or County) Circle One <br /> Date of Discharge: !/!v K,AID cv h1 II <br /> Date Notified: 6,,"2 �? _-- Time: 7: �: g2!:1�2 <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Ir Name of Business: Sal v <br /> Contact Person:_C• �`'tC.__;Jt � I�" y,�C f. . Telephone: f��,X33 ' <br /> D �v t Gc/ �! /#�cl AGF <br />' Physical Address: 6 4_74PO = <br /> Mailing Address: / v /Pr!-f ' l vr7. L�5 P4r�1 C-FG!f G4 700 <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: /G II. <br /> Chemicals: 966.Lz cam. fs ,�z �! <br /> Circumstances:_ eg,nOYA /30044:, <br /> F. ACTION TAKEN � Z.- <br />. h <br /> i <br /> 3 <br /> U <br /> SITE DISPOSITION -/,4c — <br /> C� <br /> h � <br /> EH 22 013 (Rev.4/91) <br /> . f <br />