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e • SAN JOAQUIN COUNTY • ii�e, <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL011 III U PHS-EH LOG # '0 �S <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: GiJG EPA llrrr vL- Phone: <br /> Company: <br /> Address: <br /> Designated Employee Name: A�A/2g— Phone: g65'- >•s? <br /> Reporting Agency Name: <br /> Address: /y JCJi /a+�7 <�- ST- S'i!✓t, -?vr.( �Y 5•Zu <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: //'r0z) CvG,�F !��: _/ ,vL/4Gfo,e,� <br /> (Best Physical Description) City or County) Circle One <br /> Date of Discharge: )w't� <br /> Date Notified: /' ? ' Time: u.? <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: <br /> Contact Person: Telephone: Q va G - > <br /> Physical Address: t t -row F- zye-eZ +1 -7C2 :3 7 <br /> Mailing Address: /r E 1G4�fu�/3 =5'S <br /> E. DESCRIPTION <br /> Type of Discharge: yzc. <br /> Volume: U-/V "Lizz",/-1 <br /> Chemicals: o/z- <br /> Circumstances: Cu.k/�GaQ.ZYI"T 2!lyEsr-1 G.ITlvn/ REyr�Gcr> i+r. PG Et.¢.cicE c� <br /> SLlLFiicd SJ/o Cy�LrilteliJATien/ <br /> F. ACTION TAKEN <br /> �}+ Lr� !.L-F�iivi�✓/, !�!� Ti+� f/:9._�.2Ad/1-S w.9/S 7� S%7�leiIG,E �rc'csgc <br /> u it=,sOC. iif� �✓�%/�!G SaL Lc •V TiL4+/���-%!!.�/ .Er�S .'S <br /> SITE DISPOSITION /I <br /> JylGrci TYywIVA5rE' r,� • Tu Nog„•.< -TisC <br /> r <br /> /C'c.C2�iG-"i?cy /-/i7'?i4?-i)J✓5 G✓/JsTL r/A.+L 6/e <br /> EH 22 013 (Rev.4/91) <br />