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SAN JOAQUIN COUNTY • I �� <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE —� <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: II III A(0(0,jHS-EH LOG #_ �� D� 9 <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name:_ SEFr 944Tc/,/ Phone: (.-1 SS$ - ,51'17- <br /> Company: <br /> .SlZCompany: -A.4 To.E}4✓Z n/ Pa^1-k i' <br /> Address: <br /> Designated Employee Name: N'G TeEvc'iy Phone: (Zya) <br /> Reporting Agency Name: <br /> Address: Ny5 l\/- <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location:_ / 7Z-oo s, bW-y SAI eoA-0 / �•ATNPor� <br /> (Best Physicalscrigtion) (C�or County) Circle One <br /> Date of Discharge: _y 10Z- 9 7 <br /> Date Notified: !�/1.Z/�fT Time: // = 3o5a "i <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: S+?r/ -5-o4 4,✓rl/ <br /> Contact Person: ::�,5EFc Telephone: (Zai) '55-a- G i Z'\ <br /> Physical Address: 17Gov S. N4ro-Z.4V Rv,40 L4-7;g1-ot' <br /> Mailing Address: /7 Zva <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: STo' Gal GGo�/S <br /> Chemicals: AK-4,D --vz-y ,-0A! /4PRox I3/ ° > NC.L .4,jt�> 1 %z% 1�1r�°c�FGt�krG /Iftu� <br /> Circumstances: -Sr-FF tW-o Z60 Tv /4Lrr/Fy 7Vhrt; oFF/zE 77d4-7TN41°E w45 <br /> A SD/GG oec/f� A--yo .4'T T/f Lue4 r/ocl OX tJ�i�/�ih°l£�NoTEO 4BovE <br /> F. ACTION TAKEN 'SF.FF- -1'/1L <br /> n/F.e 4 rin l ,04 <br /> GUn17�1iNFO To -T-4C 4oil -7- A/a ^iLTr 9AA -7r,//�2��/,�¢NY '-S <br /> ��� 1� ri�A <br /> SoDnl ASf� /fiids ��GTlp 727 7/fE S/�/�L i•/,ct j3j F/r/�GOY�ES hT <br /> •TitF_ Pc�/y-r' <br /> SITE DISPOSITION 6E .44O40 'M> s-ifE Ca 7 4/ <br /> srTE iJ.9TA i3�5E. Ft/.d 7dF� SirE ASK- +E.<lTr/li r-42- ✓. eE✓> <br /> � OE7�.P/-riNG T//E nlsl�✓R� ,� V/J �k?t-.QCT c-� LOnlrrl. ///J (-�^i0.�/ T7�£ <br /> �in.�c� ?moi Gv.eRLr1r(J{ C,•liIT.�7fik/U_.u= Tif£ �v/L �a OL�rE,er•,NE � rs <br /> EH 22 013 (Rev.4/91) <br />