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SAN JOAQUIN COUNTY <br /> NOTIFICATIM OF HAZARDOUS WASTE DISGfGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: 1 11 III ` PHS-EH LOG # y SB <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: 13 i l 1 Geer Of &02 - Phone: <br /> Company: S+ X05 <br /> Address: MOO p/i cv ,90 y <br /> Designated Employee Name: '6z, Phone: Q04/o?-?i�3% <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION ArD DATE OF D SC GE SAO <br /> C'/ ' <br /> Location: /�5 OD /U zy_44 —1 Cc / kl � <br /> (Best Physical Description Ea� or County) Circle One <br /> Date of Discharge: u� 02M �wt� <br /> Date Notified: ?_f_ti 4l Time: AA =3162., J <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: Sf. — <br /> Contact Person: — Telephone: Cdf1D q —&3 08' <br /> Physical Address: f� <br /> Mailing Address:E. DESCRIPTION <br /> Type of Discharge: CLn 2Q c�z� /SCG <br /> Volume: <br /> Chemicals <br /> Circumstances: <br /> � /� <br /> F. ACTION TAKEN C2 # 9V cc <br /> _ a <br /> SITE DISPOSITION <br /> dvt� 92 1 <br /> S p 1-aGtJsz�, <br /> Q <br /> EH 22 013 (Rev.4/91) <br />