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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180. 7 <br /> A. EMERGENCY LEVEL: II III PHS-EH LOG <br /> (Circle One) <br /> B . SOURCE OF INFORM Aj ON <br /> Name: (Q e to 19 (iI-1X7 C Cc� Lcd- Phone: <br /> Company: <br /> Address- <br /> Designated Employee Name: gz� r i ci ci S Phone: L� <br /> Reporting Agency Name: <br /> Address : <br /> C. LOCATION AND DATE OF D (SQFARGE <br /> Location: 5 6O > _ <br /> _3� 0 ,� ' Q � / 's f© C- <br /> (Best Physical Description) (City ovc, ounry Circle One <br /> Date of Discharge: <br /> Date Notified: _ / :Z= _w Time: (0 ) vrn, . <br /> D . RESPONSIBLE PERSON/BUSINESS , <br /> Name of Business: C� L- + � cc.__ 74wle� Ll flit S � ,ANG <br /> Contact Person: Rn to :�r , Telephone: ` ta (o -' .,355 V <br /> Physical Address �'3l 0 S lD 6; y> a <br /> Mating Address: P i� 7 �A T �� SL_ i, S to f�� rv.. e /� gs O 67 <br /> Coe DESCRIPTION <br /> Type cf Discharge: G& 19 <br /> Volume: GG� G�.F'iJ2P�2Uyc/ <br /> Chernicais: <br /> Circumstances: r S c <br /> F. ACTION TAMNN <br /> SITE DISPOSITION <br /> 4 <br /> s <br /> EH 22 013 (Rev.4/91 ) <br />