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0 SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISGdARGE �O <br /> HEALTH & SAFETY CODE 25180.7 D �Uf <br /> LF <br /> A. EMERGENCY LEVEL: I IIIII PHS-EH LOG # `� 3-0 `7� (� <br /> (Circle re) <br /> B. SOURCE OF INFORMATION <br /> Name: Phone: �) <br /> Company: <br /> Address: <br /> Designated Employee Name:Flcc, or Phone: Czc?kZ63-033y <br /> Reporting Agency Name: � <br /> Address: y 4 s N. s� O e rg U Iz — <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: z9 o f L v >t / fv\ G Pk\--t c <br /> (Best Physical Description) (City or County) Circle One <br /> Dare of Discharge: Q ��C o o�) <br /> Date Notified: 6- s - 't 3 Time: l l w <br /> D. RESPONSIBLE PERSON/BUSINESS prI <br /> Name of Business: a Ket `Jti NPeJ Se oe S f, t <br /> Contact Person: t-r � i Telephone: L=)o,) &2S <br /> Physical Address: a ti nI CS . <br /> Mailing Address: P. e. �x C'. . <br /> E. DESCRIPTION <br /> Type of Discharge: u ...U,. irJ � c ""k 140 v nJc•9ta� � IVa, S�eruC c C 5 <br /> Volume: �r, C.Ko,0 <br /> Chemicals' <br /> CiretunstanceS: m nfi .a, cn ?seowere Ups re -Aooa <br /> F. ACTION TAKEN <br /> So it !'iM worJL6�1 �( x`C-4i- <br /> S�vY <br /> 11 <br /> mv2v S:a�n� <br /> SITE DISPOSITION <br /> _ '!1v f+yll„lC enc n� !P C.rG' Pl[ rlT ?Y <br /> r � .t ro.n'c.wi.i vf4 >7N . <br /> E:? 22 013 (Rev.4/91) <br />