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SAN JOAQUIN COUNTY <br /> NOTIF[UkTION OF HAZARDOUS WASTE,DISCHARGE \A� <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL <br /> •�I II III PHS-EH LOG # <br /> Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: C'f��arl�s _ 1-J 4— Phone: CZL,,zD 41,r. ;31-%;,n <br /> Company:=�1� t, •Nt� ,t7�� ��ir�, .�,,,,_ �., >',N:��,.. 1 /1 •-r��, I')r.//</�?J <br /> Address:_ r�_ ,x a emu{� • -� �Q:IC 9szn a <br /> Designated Employee Name: CAer�-s 5' Phone: ,2412 <br /> E Reporting Agency Name: 9j. <br /> Address: '' IU_ <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: f/2r13 � A!� _ <br /> (Best Physical Description) City r County) Circle One <br /> Date of Discharge: <br /> Date Notified: =1? Time: oC2 Pr-► <br /> D. RESPONSIBLE PERSON/BUSINESS I <br /> Name of Business: <br /> Contact Person: F/,�F Telephone: coq Zw—3'7rlo <br /> Physical Address: _� rH,yrok� Roams szocA-A d'T rA <br /> 9��os' <br /> Mailing Address: &o. B�� s�t'a%o :c- „� I��A - <br /> - - - <br /> ' i <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: <br /> Chemicals: 61CIS 9>fl N II <br /> Circumstances: <br /> ���'�f /fr..rlrsr r&r,� Ca�_an►i,.a�i� II .-. <br /> F. ACTION TAKEN__ <br /> (Af-- srh -rsGP 31 4L- gevoc Coy,•r2/ � . ,. COn/ sir /�-B/As� <br /> �T'rr, Nivc/ /QT <br /> St- <br /> f an y. Sr.�ZTS <br /> II <br /> SITE DISPOSITION <br /> II <br /> r; <br /> ii <br /> IT <br /> II <br /> EH 22 013 (Rev.4/91) �i <br />