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� qL ..-- <br /> • SAN JOAQUIN COUNTY 0 D <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE �Y <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: . II III PHS-EH LOG <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: �JtgA Phone: - <br /> Company: Cameo 1) <br /> Address: /2-670j 44)j 9� G A u 47eec& <br /> Designated Employee Name: Phone: �) <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: /woi S i1°Lg <br /> (Best Physical Description) (City or)aoun�7 Circle One <br /> Date of Discharge: cy <br /> Date Notified: Time: /:/ oA <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business:, /�eF�Ca�c L/�kr ,.�• a <br /> Contact Person: '60� pk. __ Telephoner Z N9- /ZiS <br /> Physical Address: 21 1 , <br /> Mailing Address: S/,t <br /> E. DESCRIPTION <br /> Type of Discharge: 50..:x' <br /> Volume: 17;'l-') txj <br /> Chemicals: Q c Q `�> 40( L- <br /> Circumstances: .[.G'P �aGce y, uu« tilt <br /> F. ACTION TAKEN 600 Oa • ('o&-�Kt :vim 44,tlewd u.kA,, LlWiLe <br /> lVaJ., <br /> e.e4DO t N I� rc� <br /> fit 7 JLL /.LGv4.✓. f / <br /> SITE ST USS <br /> EH 22 013 (Rev.4/91) <br />