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SAN JOAQUIN COUNTY COPY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: DI II III <br /> PHS-EH LOG i�24 <br /> (Circle One) <br /> 3. SOURCE OF INFORMATION Phone: ( `�`�2.0 603 <br /> Name: 12+°1 p-R Gt MOPN <br /> Y� <br /> ComP an Gt'S + or � Er IV IT�o� Dtien � <br /> Address: /D 51 ED ft D E L1t5 Qu l � 5 u r� SS �SC� o.a r Ut �7 a�1�o <br /> Designated Employee Name: 11 'l 'a r - Z S^' A i�' Phone. (Zd) V o <br /> Reporting Agency Name: Sr�K 'TeP iti ro PNb/ Ei �AI.Tt� z�l cx5- t�17 <br /> Address: P o• 6,2)4 <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 3 (City or County) Circle One <br /> (Best Physical Description) <br /> Date of Discharge: �1rJ ISS �'"`4 <br /> Date Notified: l2��-tel L Time: I D ! o o F4 M <br /> D. RESPONSIBLE PERSON/BUSINESS SVZ p'� <br /> Name of Business: ��f 2 e� <br /> Contact Person: KF-tj P r% { RAR-o2 Telephone: <br /> Physical Addr8'06-oQ,942- (L /lo `' te') I - <br /> Mailing Address: — F 6tJT5 <br /> Mo R- L L � C.o4 R Sa 3 f <br /> E. DESCRIPTION <br /> Type of Discharge: �l " <br /> Volume: <br /> Chemicals: c.6�(oo j S <br /> Circumstances: P <br /> ezwe <br /> F. ACTION TAKEN c-p a r <br /> P-1 4?- SS <br /> iJ Z. ISL SITE DISPOSITION— <br /> DISPOSITION (1 i � C55 <br /> ,L of r Inn i �� I t✓� <br /> e - bio [ tiKGe1 <br /> a �o 4 <br /> EH 22 013 (Rev.4/91) <br />