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SAN JOAQUIN COUNTY .� <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: if III PHS-EH LOG #_- <br /> (C! cle One) <br /> B. SOURC OF INFO TION <br /> Name: ' £ Phone: 5lo -e ZZ y <br /> Company: <br /> Address: 31t Ca ¢SZp - .eG <br /> Designated Employee Name: Phone: C__) <br /> Reporting Agency Name: <br /> Address: n' / <br /> C. LOCATION AND DATEOF DISCHARGE <br /> Location: Zl.a/ / <br /> (Best Physical Descri tion) (City oCo Circle One <br /> Date of Discharge: <br /> Date Notified: <br /> D. RESPONSIBLE PERSON/BUSINESS ; <br /> Name of Business: <br /> Contact Person: Telephone: — 15 <br /> Physical Address: 0 2-/5 gSLp <br /> Mailing Address: Ak-xLA <br /> E. DESCRIPTION <br /> Type of Discharge: _alx� <br /> Volume: <br /> Chemicals: 6 . e<c� <br /> Circumstances: /VDt/ 9h <br /> de z �c 4�aoepfJe.,�e .cam.-moa�l Eu� <br /> e <br /> F. ACTIONTAKEN / ) G� �-���-; o� � Loci• Q �lJ�c.sc�l>(�[e�L�„� <br /> S.✓. - Go P. <br /> SITE STATUS 1 <br /> cC G s <br /> l <br /> Z Gc <br /> .-2 f <br /> EH 22 013 (Rev.4/91) <br />