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• SAN JOAQUIN COUNTY 0 <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II IIt C <br /> ;�`✓�� � H LOG # <br /> (Oircle One) J <br /> B. SOURCE OF INFORMATION <br /> Name: DOnn6k 14l -sue Phone: 532-0800 <br /> Company: L06raknr',mo c� <br /> Address: 0 l Kq�SgS e <br /> Designated Employee Name: [ Phone: (ZLI) ' e-8 -34/68 <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE / <br /> Location: ��� L�i.� U�• E/�(h� /� �C�C4t / S 6z <br /> (Best Physical Description) (City o ounty) ircle One <br /> Date of Discharge:, Ll nEnoz)� <br /> Date Notified: Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: ma'n -- (4LY)'5 MGILCYwr <br /> Contact Person: �j s 1 Telephone: (2� a,,5( -'l Lg35- <br /> Physical Address. 157C5- µti - <br /> Mailing Address: �Clnm SL_ <br /> E. DESCRIPTION <br /> Type of Discharge: l G� fYGn r (/J!/ [ 2 <br /> Volume: _ L�nK�2cv�Yt <br /> Chemicals <br /> Circumstances: / <br /> V <br /> F. ANION TAKEN <br /> 7 � <br /> SITE DISPOSITION T i Gd jz <br /> c � <br /> r <br /> EH 22 013 (Rev.4/91) <br />