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SAN JOAQUIN COUNTY <br /> NOTIFICf TTJN OF HAZARDOUS WASTE DISC -.,RGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A EMERGENCY LEVEL I II III PHS-EH LOG <br /> (Circle One) <br /> B. SOURCE OF INFORMA'WON Phone: ph) �6z3 R15� <br /> Name. ��! leu 0✓L <br /> Company r w o c r �P.nrtG - /.Qh >o�t➢✓tf� <br /> Address: <br /> Designated Employee Name: Phone: <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: E �ose►r., - / M� � <br /> (Bests Physical Description) ty r County) Circle One <br /> �g <br /> Date of Discharge: <br /> Date Notified: 7:�• 13L13 Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: o✓ti s f `clot ^ dee' �r l..aSl� <br /> Contact Person: L.0Telephone: <br /> Physical Address: -+ �ei' Fca` CA- q5-3:? <br /> Mailing Address: 14 4 t l Sud l �� co g5323) <br /> E. DESCRIPTION <br /> Type of Discharge: cow� dc <br /> volume: V Bksu <br /> Chemicals: - 5ccf, -�v LL-al—P-4 Lcl � <br /> Circumstances (2Q taw 21Qt^C 1H i tC�l r�Sv l}S or l I�^ <br /> PSCCG-ucfta✓1 <br /> F. ACTION TAKEN <br /> SITE DISPOSITION St vc.D �itn^Cr rstlarl e � <br /> -fes o/�fuv� Si v <br /> l huzs+� �-f-1,o-� a v2 l5J ( l^ a u ✓ c <br /> py 1 t/ C!i lti <br /> EH 22 013 (Rev.4/91) <br />