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SAN JOAQUIN COUNTY <br /> NOTIFI ,i ON OF HAZARDOUS WASTE DISOLARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: �II III PHS-EH LOG <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: fl o n =-co Phone: (.OdO 5S- q-+ <br /> Company: OAi_ EPF1- -oEP"f: r�F 5U85-a nci-� <br /> Address: �O) rq- 9 G <br /> Designated Employee Name: Phone: (2c� 4(o R- 4�71 <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 2-2n) 0. (,t]n,-h n ;jna '✓F. 4S / fi <br /> (Best Physical Description) (City r County) Circle One <br /> Date of Discharge: I P knC`e.un <br /> Date Notified: —�,*9l Time: 30210M <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: (,d,oTr F > .ue2 Sc ,�r62vn <br /> Contact Person: crnkn©uwn Telephone: L_) <br /> Physical Address: 22©) Lo_ t�Yrch rrn � ik�n <br /> Mailing Address: Sf� <br /> E. DESCRIPTION <br /> Type of Discharge: Ll r0,(,64n on2edS�o(-LIQ I rd on,--e P6 ) nnin nr nk rrr <br /> Volume: l.lr k y,, t r) <br /> Chemicals: _VA,nraAC,ixv,- q-Qick, 9 n1i-)� � c.t\rth 7FeA &,h c�-F=1, P� t <br /> Circumstances: fm mole rn--su (t, 64' bed as ce J'Pq-ls;I <br /> �i�nt/�✓r nrttnr( iii � nit i,ry� njnrl QIcl Q . <br /> F. ACTION TAKEN tri' 0,3h rtv-)d c r n,� -E It an s rt . T--Lv-thar- alEk <br /> asef ;vawA$ �n n (Ic�,-)MU,uo , '4� o Y>/AYti(.'L.l °f-n.�tto 44- `� <br /> 1AS t-A vvw,A/iT T <br /> SITE DISPOSITION ThC bed SIM e i GISh W i(I �-n,y 'fin kae Irn vm e<( <br /> 05 <br /> EH 22 013 (Rev.4/91) <br />