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SAN JOAQUIN COUNTY <br /> NOTIFICA-ZION OF HAZARDOUS WASTE DISL�ARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL• I I III PHS-EH LOG <br /> ircle One) <br /> B. SOURCE OF INFORMATION <br /> Name: i5AIZ— Phone: 4, s <br /> Company: <br /> Address: <br /> Designated Employee Name: A°fe -7—"Yf t//� Phone: 2�z X68-3Z3El <br /> Reporting Agency Name: <br /> Address: q�l t N- 54AJ �2e-ko2,�c,( ST, S�a-�/j <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location:_ 225 / <br /> (Best Physical Description) (City or County) Circle One <br /> Date of Discharge: fDwtJ <br /> Date Notified: / Time: 3 /5 O wt <br /> D. RESPONSIBLE PERSQN/BUSINESS <br /> Name of Business: AWD e4 <br /> Contact Person: / �-D0V Telephone: (2��t 3 �s-72G3 <br /> f Physical Address: o00 S 54,6L ZL4- hyo <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: liNAfr,7)bQ2�, L <br /> Volume: 11NKNDwI-4 , <br /> Chemicals: /,�,00p <br /> Circumstances: 11K1-),ep4Aod °gtJ OdoA6 I S61L t�ist000,e,QTinnL <br /> F. ACTION TAKEN !/N06c2-64001M --rkWX:5 464z%VCJ> <br /> SITE DISPOSITION !//life 64OP1,Jn sT,4,4lr�Tid�V,C �'onri� N•d�'�o� c <br /> L Dov c�,ly�f cv r Tt! 1,1A., A6,4z)AT .40) A104irQ TD <br /> rvA-nyc,4.- / 2kA2 AicE ,d <br /> l44!e oSL' F D f-lD o4ND/� Gv12409!G is <br /> r <br /> EH 22 013 (Rev.4/91) <br />