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. Mt'`j .+- U4az� <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE. D CHARGE <br /> HEALTH & SAFETY CODE <br /> �. EMERGENCY LEVEL:G) II III PHS-EH LOG 13 <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: 57,? su - i� �� s Ge l� Phone: S�.� -o 7y D <br /> Company: A Ca <br /> Address: ice, 60 57�rl <br /> Designated Employee Name: r_c., l C'-v Phone: ( ) -t <br /> Reporting Agency Name: S , C, <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 300 s- cG�l���-�%� / S� -7 <br /> (Best Physical Description) Cl r County) Circle One <br /> Date of Discharge: <br /> Dace Notified: Time: s.2 <br /> D. RESPONSIBLZ- PERSON/BUSINESS <br /> Name of Business: <br /> Contact Person: Telephone: (toy <br /> Physical Address: u?, <br /> Maung Address: <br /> E. DESCRIPTION 6/ _ <br /> Type of Discharge: -'/"�-"7/ _AG� <br /> Volume: Ile- -- <br /> Chemicals: -- <br /> Circumstances: <br /> :. ACTIO N TAKEN —ZL <br /> SITE DISPOSITION acs�e-ra ,z ,��tu! � •/�• <br /> H l-r/�,Cf� "f P ,�/n />l r✓ s_%..n i uGt�C%' �'S 4 0� iir,.i� �J /Z✓ C/J ��,;-L� - <br /> G � <br /> o� „lam � 4� .►.�► <br /> EH 22 013 (Rev.4/91) <br />