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SAV JOAQUIN COUNTY <br /> NOTIFICr\TION OF F:.-\ZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:CjII III PHS-EH LOG # <br /> (Circle One) <br /> I <br /> B. SOURCE OF INFORMATION <br /> i Name: 01,/1. N, rs-_R- ! Phone: (_) <br /> Company F�2�/l Ci" `'" ��✓YI��4J <br /> Address - S <br /> Designated Employee Name: Phone: 0703 6� /, <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: /!j.3 e� TQ /- ( Y7,gz / D& <br /> (Best Physical Description) (City r County) Circle One <br /> Date of Discharge: <br /> Date Notified: l Time: L T�yry <br /> D. RESPONSIBLE PERSON`BUSINESS J c� <br /> Name of Business: <SY�LC f��^yJ 2e4t,(�i -ad74 <br /> Contact Person: 0 LQi tj��,,Lc Telephone: L) 453- X757 <br /> Physical Address: / 3 !� Yl 171c l 14'�G(��zj�•� �7So�p�, <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: M14 <br /> Volume: <br /> Chemicals-. 1-7,01 <br /> ircu tances: <br /> A a� `�o�-�, /990 -Pi 1/sem <br /> gee <br /> G� <br /> i <br /> 5 # J v�- <br /> SITE STATUS <br /> c /�Q P o <br /> EH 22 013 (Rev-4/91) <br />