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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> C/np" Z <br /> A. EMERGENCY LEVEL:011111 II III PH <br /> O LOG #-'7 V0�6 <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: M&- Phone: 11 4�4-93 8 <br /> Company: L064-. )0(-. <br /> Address: <br /> Designated Employee Name: - Hi Phone: - Z <br /> Reporting Agency Name: rJ <br /> Address: 44t t)• SrhJ Jr u I&� ';:;r 5h X tj <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: IM W q N-N E / Ste' C <br /> (Best Physical Description) City r County) Circle One <br /> Date of Discharge: u QkNe,3 <br /> Date Notified: 3- �1- -q I Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: -LU A' QC- <br /> Contact Person: 94 tnk s Telephone: (ILD 891 - 3(0-7-0 <br /> Physical Address: FQ9 u art+ CA- q4oGo <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: IJt F-SEL F0 E t✓ Rauk L1 0n£-1zC-au N6 Stun-,- E Mt 1!c- <br /> Volume: aO <br /> Chemicals: t ESEL. . o LFa I rte Fhtt�(Lo c.U�t_r s <br /> Circumstances: AS essntcv&i-r P�w,-- - b rG-ta Al 94 199I C,&M r-t CMSi� -MtS <br /> PB.ESI�MCF- POP rP►EseL. (gnuOftt� 10 W CLLs 61-t <br /> S PTFE w kq P Re�. <br /> F. ACTION TAKEN Sits e u"E n:. I?t u-ptLcn u& S BksEss,n��-Tr t uy 19r 3 -RD <br /> VCS!0C- -rrtF • FIA LL 65TgN''C" nT- SD t L #Wb c,-9tlA ND UJA-fefL_ t w A-TLW. S►TL <br /> IS 10 11JIG LMQk-L- ON S-RS L& <br /> E7Cl r C.�4'Rm.) tS B'Etu(0 w A t>E As k RESt,t LT 8'F STkF-F- a cV t Glo &F <br /> SITE DISPOSITION CtDN-Cl ►Ju.C� tesScitFaNuIrIN <br /> EH 22 013 (Rev.4/91) <br />