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SAN JOAQUIN COUNTY FILE COPY <br /> NOTIFICATION OF HAZARDOUS.WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVELI II III PHS-EH LOG# D3—��o <br /> cle one) <br /> B. SOURCE OF INFORMATION <br /> Name: o`aNb S1M ik� Phone: (tet 339 <br /> Company: F 1�j i" -j"�q✓e/1 q t <br /> Address: IS I DO o^rJ �r401v� <br /> ' C R <br /> Designated Employee Name: r4 YG v-� Phone: 20 b - g <br /> Reporting Agency Name: N To kt C . n!u �°� M(t ( . <br /> Address: 3 0 <br /> C: LOCATION AND DATE OF DISCHARGE <br /> Location: I 00 _Mb,f'N � LoDI 42Q ( County Circle one <br /> (Best Physical Description) City <br /> Date of Discharge: <br /> Time: I ' P� <br /> Date Notified: 0 I I o I e Z <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: ( f �S_ T11 4-vt P(� <br /> Contact Person: b 4r r-,b A S�^'► I Phone: Zoe3°� - 1'1 b(o 6 <br /> Physical Address: ISI OD -1 L'.&P <br /> Mailing Address: aE. DESCRIPTION <br /> DESCRIPTION <br /> Type of Discharge: rev ." t`.5 q^-6`u ovl? Q, <br /> Volume: '%, 11 <br /> Chemicals: <br /> Circumstances: 4 ICA I <br /> F. ACTION;I'AKEN Il9��l wy'rb 'v 4 ct,��:�-° '��,1� �L o.�.,fd �n►'� <br /> f <br /> SITE DISPOSITION 4ZY 11 tc <br /> La- [,VIA <br /> EH 22 013 (Rev.08/20/98) <br />