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N <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 251M7 <br /> A. EMERGENCY LEVEL: Q II III PHS-EH LOG # 1 r2f J 13 <br /> (Circle One) <br /> B . SOURCE OF INFORMA ON n \ e <br /> Name: (f� P_ cq) a_. kc?� Phone: <br /> Company: <br /> Address: <br /> Designated Employee Name: ke, c� im:� r i Q 5� 5: Phone: L� <br /> Reporting Agency Name: <br /> Address : <br /> C. LOCATION AND DATE OF DISCHARGE //jj ^^ <br /> Location: 3 10 t_� .2 , DO-`r CP do <br /> (Best Physical Desciption) (City a ounry Circle One <br /> Date of Discharge: <br /> Date Notified: _ =L7=� Time: <br /> D . RESPONSIBLE PE.RSON/BUSI1NESS <br /> Name of Business: C/+ L + -rs�&%A�tAicc. 74W II� Ll 06ZNG <br /> Contact Person. Rn h 2 r 'h f2e&69 -hr . Tellenhone: ( 0 ` ) `f (o 6 - .33 <br /> Phvsical Address: S . iD S <br /> Mailing Address: <br /> �. DESCRIPTION <br /> Type of Discharge: GL <br /> Volume: LG Y�.�'sYti19Z Uyt� <br /> Chemicals: <br /> Circumstances: ct <br /> F . ACTION TAKER <br /> SITE DISPOSITION <br /> EH 22 013 (Rev. 4/90 <br />