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AN JOAQUIN COUNTY <br /> NOTIFICATAOF HAZARDOUS WASTE DISCIWE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVELQI II III PHS-EH LOG # — 1 q <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Q m Phone: <br /> Company: 0 F. k Tr1C <br /> Address: Z Q cr 2 ZG <br /> Designated Employee Name: �32 m Vin(n �4 Phone: (,Db NLS -3elh R <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 2 ZO f w � W(ttr1 i LCj"+0)-\ / SfD rt <br /> (Best Physical Description) Ci r County) Circle One <br /> Date of Discharge: 07) L'Qe <br /> Date Notified: 2/ Time: //1'00 fpm <br /> D. RESPONSIBLE PERSOWUSINESS <br /> Name of Business: POr-1 d-IC S*CK� <br /> Contact Person � �t�f v� Telephone: Q ) 94 -024(,o <br /> Physical Address: ash OEt) ctl-{zl- <br /> Mailing Address: .b , 904 2L205TS 1rc fzm 9 S / <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: <br /> Chemicals: a o !i - <br /> Circumstances: r;Ze -Goa E-Linq= t9huuZ oDu. <br /> J.)T rg rM6VM- <br /> F. ACTION TAKEN :i✓ll< rem6yo-t S2�4a e-j <br /> SITE DISPOSITION !na / Ld 'Cc r <br /> 1 Ye " i <br /> .a <br /> �Hd /or eV2ulor . <br /> EH 22 013 (Rev.4/91) <br />