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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE 1N� <br /> HEALTH & SAFETY CODE 25180.7 COP <br /> A. EMERGENCY LEVELO II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: /i1 c C[.M,n o// Sp /! S n/P s Phone: s,0 7 -/,r - 2 D <br /> Company: .5" <br /> Address: <br /> Designated Employee Name: ( .c ,�1 r, Phone: (22t) ti�c Y- <br /> Reporting Agency Name:_S C� , Lit, <br /> Address: WV5 ,..2, S%., roc c <� .5� 5,hV E l Y r� ss av , �( x <br /> C. LOCATION AND DATE OF DISCHARGES C <br /> Location: w g v r £. C� r e, v /;s /(� / U 1 r� <br /> (Best Physical Description) (City or Co�Circle One <br /> Date of Discharge: u / . <br /> Date Notified: y/a!?3 Time: 4 -t v� <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: r, , k1 <br /> Contact Person: 7 c,rt f L-�« Telephone: <br /> Physical Address: <br /> Mailing Address: s s / s/CLJ, <br /> E. DESCRIPTION u <br /> Type of Discharge: <br /> Volume -..��„ •w <br /> Chemicals: 64 so/. /� <br /> Circumstances:_ 5,�;� 5 c, n ,le re 5S f4x I-vurv+ iG AE /, (,7 <br /> F. ACTION TAKEN T, ks U o„ z ,o./ cv cA 5 � 9 s <br /> SITE DISPOSITION ru Jlk 5;1r atsosr;�„T ��5 �r .w xsns to e��k� <br /> _/1�-�cA<O t t. <i..1 .1• io n-�.�,.Hcc1tv%+ i s 40 - .-.��c�/..2o c -� <br /> i <br /> oa ,.1� v 45 nr1 �. • <br /> 71-122 013 (Rev.4/91) <br />