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0 SAN JOAQUIN COUNTY •NOTIFICATION OF HAZARDOUS WASTE DISCHARGECOPY <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: <br /> �fI III PHS-EH LOG # <br /> One) <br /> B. SOURCE <br /> OF INFORMATION <br /> Name: Fh,� I'{' cCn rill Phone: <br /> Company: 1 <br /> Address: 991i) IV-94A- Rv+, Rd ecus <br /> Designated Employee Name: Phone: <br /> Reporting �.A ency Name: <br /> Address: D 15c D3 cls Dov [/� `r%oi <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: llo prieil•6 0-0-e <br /> (Best Physical escription) , Wor County) Circle One <br /> Date of Discharge: <br /> Date Notified: Zz 9 Time: /0;00 A -" <br /> D. RESPONSIBLE PERS N/BUSINESS <br /> Name of Business: Zu4 Ce'�^ <br /> Contact Person: vv, c. :.+2 Telephone: <br /> Physical Address: o MLc=1Clw� <br /> Mailing Address: R u, � SA _L 60 <br /> E. DESCRIPTION <br /> Type of Discharge: �, f� •r2 <br /> Volume: <br /> Chemicals: a,A tot e- w,.-- wcZw <br /> Circumstanc : �m `� <br /> F. ACTION TAKEN ✓ `' <br /> SITE STATUS fsr fes. CLu A4, �X <br /> fN/irr a� rK t U./2m l <br /> f�-ZR 7D <br /> v U <br /> EH 22 013 (Rev.4/91) <br />