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� SAN JOAQUIN COUNTY 1 �' <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:�II III PHS-EH LOG # <br /> vy� <br /> i cle One) <br /> B. SOURCE OF INFQRMATIQN <br /> Name: i'CLVn V e �QPhone: �y6 -0335 <br /> Company: <br /> Address: <br /> Designated Employee Name: 0ia1 VIOL4Phone: L(/% -G <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATIONAND DATE F DISCHARGE � <br /> Location: Mn"a-r1 a- I1 i v 'L (.-Lt �)t 0/1 <br /> (Best Physical Description) 5ta-ZUi iry or County) Circle One <br /> Date of Discharge: �l/✓)KY�Ctiul 1 <br /> Date Notified: Time: I C C M <br /> D. RESPONSIBLE PERSOJV/BUSINE <br /> Name of Business: i t 0 S-bCK <br /> Contact Person: - v Telephone: 4 U - 9 3 <br /> Physical Address: qZ i n. • F 1 7cre <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: eo K rcyn US' <br /> Volume: <br /> Chemicals: <br /> Circumstances: <br /> �t <br /> F. ACTION TAKEN -72-t,2K r,�7m CV a <br /> I <br /> SITE DISPOSITIO 1 C� rm4<1n 6✓i / `z24z4kuz- 6j'/ <br /> -) <br /> 1 'lJLt3. i <br /> EH 22 013 (Rev.4/91) <br />