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E SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISH GE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:pircle <br /> II III �' �=�, ,,-PHS-EH-LOG #_.�1/ <br /> One} <br /> B. SOURCE OF INFORMATION E `. <br /> Name: Z577/—. ._ Phone: ( , 666-110 <br /> Company: g:� IVQo T7-4 G-O 7z-7 4511 <br /> Address: ! 1 �?-S rVo <-r,,t� !Z51 C>. —"2:2e c--1 3S ! <br /> Designated Employee Name: Phone: ,-z;-7 <br /> Reporting A ency Name: <br /> Address:_ _o- 90 Xr 0.0.0S-77Z--.� aril C ,r r Za / <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location:(Best <br /> A- <br /> (Best Physical Description) I (:�r County) Circle One <br /> Date of Discharge: <br /> Date Notified: '" cr/ Time: lU.- dv <br /> D. RESPONSIBLE PERSON/BUSINESS 4 <br /> Name of Business: T --• ef>�� C'4a,4-P I <br /> Contact Person: Telephone: CrA.6 -- ae <br /> Physical Address: -7vo �5?4-7 <--�-, CET rte! cU z r3 0 <br /> Mailing Address: ?yta 57:*7- <br /> i <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: <br /> Chemicals: <br /> Circumstances:_ Vr +i vF S.04(L <br /> _y jAIG rolCr rc>V , .z-C< /CtV <br /> F. ACTION TAKEN <br /> is <br /> SITE DISPOSITION <br /> G//!G./� f3� 1�c�Gy.4F�h��I�.„�l Tim! y�{�' /�EI�p_�� /��lr��..��/J,E•n Ty <br /> ! f�l�'T•'�•tl,l/V.d7",�f� s!�-� .i-7�'-T/�� iN r G>Q^:/-�/ ��/I/E�7'r!�'�`i'u, <br /> A/</r -4rFp/x�TC�! Yr%C�IAF <br /> 'o <br /> i <br /> EH 22 013 (Rev.4/91) ;} <br />