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' 04-10-1995 09 25AM FROM TO 19167867830 P 02 <br /> K I <br /> vL <br /> SAN JOAQUIN COUNTY (C(oNOTIFICATION Off' HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMF.RGEIVY LEVEL.(!�tI III PHS' -EH LOG # 5� <br /> l7� <br /> (Circle One) <br /> B. SOUACE O' INFOkMATION <br /> Name: Phone: vr• 0 33 <br /> Company: I S 7r — <br /> Address: I <br /> Designated ployee Name. Phone: �) <br />' ReportingA envy Name: <br /> Address: .c ry <br />' C. LOCATIONND DATE OF DISCHARGE <br /> - Go <br /> Location: <br /> - y��i� Ply <br /> (B st Physical D sc;ipuon) County) Circle One <br /> Date of Di=rge-I <br /> Dare Notified. 9 Time: 2 ao�y <br /> I <br /> RESPONSIBLE PERSON/BUSINESS <br /> Name of Bu ess- t/FG� 5 ✓l .47"�a� <br /> Contact Pen.on f Telephone. <br /> Physical Address: ' Z� 9 <br /> Mailing Ad ess: <br /> 11E. DESCRIPTI ,N <br /> Type of Discharge A rz_E <br /> I Volume. i ri a <br /> Chemicals: I yAsd r <br /> Circumstances: a7 Q <br /> F ACTION TAKtEN �� .d !ia <br /> I <br />' SITE STATUS <br /> S <br /> r <br /> � r � <br /> I <br /> EH 22 013 (Rev.4/91) <br />