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w J�G��U <br /> • SAN JOAQUIN COUNTY 0 U <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: D II III PHS-EH LOG # '71 <br /> —� <br /> (Circle One) <br /> B. SOURCE OF INFC)RMATION „ <br /> Name: o (J .�l eY� Phone:,tLO5 �7._ L <br /> Company..-._— (�a �( C�— l ✓�cL�F?�– �rr � <br /> Address: __.l�f C Y vi � L-d o e Sic U fflbV� (i-4 9 5 <br /> Designated Employee Name: Phone: (_) <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: -74q S - CA � V-Y-N <br /> (Best Physical Desct oription) County) Circle One <br /> Date of Discharge: [A(1 �L 41 �'l <br /> Date Notified: Time:�S: - <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: S'0 Yrin- -F-& <br /> Contact Person: 5se vTelephone: <br /> Physical Address VI ei C` 1 (?C <br /> Mailing Address: tiff,a 4 ,,4a EL L G2C, <br /> E. DESCRIPTION <br /> Type of Discharge: I !L1 k-VI kl <br /> Volume: ADV "Yn <br /> Chemicals: <br /> Circ tances: <br /> F. ACTION TAKEN `�6 0 L <br /> SITE DISPOSITION lA <�T/firl m lg*' d <br /> JV�Il,�ti1n 1011 to <br /> EH 22 013 (Rev.4/91) <br />