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i <br /> FILE COPY <br /> SAIF JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCYLEVEL:CI) II III <br /> PHS-EH LOG <br /> (Circle one) <br /> B. SOURCE OF I IFORNLATION <br /> Phone: (&9) 5 3 7 55 <br /> Name: ari A KO—to S i'S <br /> Company: RS �ru- Gh-5i+C. <br /> Address: PD BOX 2243 Lh' Khrr ImpCYk 924y7 <br /> Phone: L[n.tiivu• ��iD� <br /> Designated Employee Name: 01ra7AL011 <br /> rOn Gs�(. <br /> Reporting Agency Name: 95102 <br /> Address: 304r- <br /> C. <br /> 04 C W'ef " yr <br /> C. LOCATION AND DATE OF DISCHARGE <br /> i / cS"�DC k-tara <br /> Location: �In�i I)UG fC ee -T� �or County) Circle one <br /> (Best Physical Description) L� <br /> Date of Discharge: n <br /> Time: /S <br /> Date Notified: 10 21 <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: GI l ruG(C <br /> Phone: <br /> Contact Person: q5215 <br /> Phvsical Address' 3u � <br /> o � n <br /> Mailing Address: D7 <br /> E. DESCRIPTION <br /> Cca,a.e- <br /> Type of Discharge: V LvQyn <br /> Volume: <br /> Chemicals: I' S r V t <br /> Circumstances: <br /> F. ACTION TAKEN <br /> SITE DISPOSITION <br /> EH 22 013 (Rev.08/20/98) <br />