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0 SAN JOAQUIN COUNTY 0 <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:/ I�j I IIT PHS-EH LOG # �1 <br /> rfcle One) <br /> B. SOURCE OF INFORMATION <br /> vn !a Phone: 603-7Z -13q <br /> Name: 3 <br /> Company i% C(20 <br /> Address:—j 5 -1CLivd r� Sacra r Csl 9Slo <br /> Designated Employee Name: 'tozL2 1h Phone: (LOD Qin P cl c <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DIS GE <br /> Location: /515 td, V.el� ( 14101 /3251 /5ql <br /> (Best Physical Description) <br /> ity Cor County) Circle One <br /> Date of Discharge: ' <br /> Date Notified: (114q, Time: <br /> D. RESPONSIBLE PERSON/ US NESS <br /> Name of Business: C 2 <br /> Contact Person: Telephone: /h <br /> Physical Address: 2b1 l�V)I�1 Q� ' <br /> Mailing Address: -,Sge2� <br /> E. DESCRIPTION K n <br /> Type of Discharge: led <br /> Volume: <br /> Chemicals: <br /> Ci ctmmstances: � o a lam✓ O Gc rn <br /> fuL(inv i15T �y� Ev�P <br /> F. ACTION TAKFN, �- <br /> v <br /> -7 <br /> SATE DISPOSITION fame ra« 'Q1 <br /> 747 l � i✓ 4 <br /> EH 22 013 (Rev.4/91) <br />