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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE D CHARGE <br /> HEALTH & SAFETY CODE <br /> v <br /> A. EMERGENCY LEVEL:(3) II III HS-EH LOG # 13 ,oYI <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Phone: (2;f 3 S�� '09U� <br /> Company: A <br /> Address: ir23i <br /> Designated Employee Name: (- caPhone: (mac ) -If�cY 3 + t�j <br /> Reporting Agency Name: Sn. Two 4 Z K1,1 c "t, `2^ V"' - <br /> Address: ws A-2 5-4, <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 3oo s. r Count},) Circle One <br /> (Best Physical Description) <br /> Date of Discharge: Uhl-'? <br /> Date Notified: /f3 Time: vW Pin <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: <br /> Contact Person: Telephone: <br /> Physical Address: y3� aJ Sw�fs u? S�vcEf /9 Quos <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: Ax r �� <br /> Volume: n le-ti <br /> Chemicals: 6r, 5 oCLh r , 1% _ <br /> Circumstances: !�o <br /> F. ACTION TAIMN 77t.,-A-5- <br /> SITE <br /> Zi.,.lsSITE DISPOSITION <br /> EH 22 013 (Rev-4/91) <br />