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SAN JOAQUIN COUNTY - 4 <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: hennefv-% wc-ytl Phone: 20 95Z-a353 <br /> Company: C`wAavi t e <br /> Address: A�3 wvs+- ILLca-cjn L-c� <br /> Designated Employee Name: Phone: (_) <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 4343 5: <br /> (Best Physical Description) (City o County Circle One <br /> Date of Discharge: Unknow ✓1 <br /> Date Notified: 1. 3 •R3 Time: O <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: LSLrnc +Lp-1 t1e51Le- <br /> Contact Person: Telephone: Pei ) 9 q5-!t-3 z <br /> Physical Address: A -4 3 5;-- �1i- 75TOG fru. q!5 Z(5 <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharger Ln.e-i,r✓r- <br /> Volume: w e1 <br /> Chemicals: LLtcla rvi 6yoCor'0a/1S '- akLc)v-w-Lr-kdSo(uen <br /> Circumstances: W.VieLJ Of Ovlcln.[G rcy SiDrr 4 r^Qn10LJ <br /> F. ACTION TAKEN l)nG(o�[t r o L1 r� 'I-C[.YL K ✓ fvI bJQ.D '-Zb Q C=e <br /> ALSCy aV�i <br /> SITE DISPOSITION i � ST LD vA{-c[m[ �a,����./ �(_ L 0 to _ C Cu <br /> L-)[tin, 1-� D,- Q-�LG cLL[LLa <br /> Lrtcc Slso- . d (Vl✓PS 4 <br /> yj[L1 u[ e e?fD o r CV 9[J <br /> t Ll <br /> EH 22 013 (Rev.4/91) <br />