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N <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180. 7 <br />'t <br /> A. EMERGENCY LEVEL II III -EHLOG #(Circle One) <br /> COPY <br /> i <br /> Be SOURCE OF INFORMATION <br /> Name : k ' 1�. L,.n c?E W 1 Phone : <br /> Company: <br /> Address : =,L, 7 l c C _ r_7 �_P ': n ,-.rr� r,,�r� , 1�� 4 �' s� ;17 <br /> Designated Employee Name : Phone : (� <br /> Reporting Agency Name : <br /> Address : <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 1 L � G1 C" ar-{ t'_ I' <br /> (Best Physical Description) ACity,,6r County) Circle One <br /> Date of Discharge : Iui*41MOC) <br /> Date Notified: I I: —�( Time: %Oh <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business : � nnel � can `f ri•LI ( ter, i� <br /> Contact Person: 000000 v'\ 'ncn-tekk vlc Te ephoriib : flb <br /> Physical Address : <br /> Mailing Address : Bzx <br /> E. DESCRIPTION <br /> Type of Discharge : {eCk- <br /> Volume : L ( 0 lz 61 1 �Yl <br /> Chemicals : 0�mj so F e C? <br /> Circumstances : 1 F _ ur) _r 6_ Z01- : r c�rvim, <br /> F. ACTION TAKEN fU n <br /> SITE DISPOSITION ( ( ? r act' ccoPPit-4- C4iAi YQGIIPL� (ct him <br /> Cil �r^��a_ _I �1a S 1�cJF i � uPsrGG. ter, �; I lir (Jr Lr1 <br /> t'_ /�.. ✓'c'i�J,n 1' ',� ni�irzr � . <br /> EH 22 013 (Rev.4/91 ) <br />