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SAN JOAQUIN COUNTY mss•` <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> 1 HEALTH & SAFETY CODE 25180.7 <br /> ' C(ap HLOG # <br /> A. EMERGENCY LEVEL: i� II iIi <br /> ( ircle One) <br /> B. SOURCE OF INFORMATION <br /> Name: , 7�'6�n v-e� Phone: o l 8 _7�L,c� <br /> Company: 2c✓ w -Z <br /> Address: ziSo .ve ('A 'N41V� E l/c <br /> Designated Employee Name: Phone: -� <br /> Reporting Agency Name: <-cw <br /> Address: c'• 3 4 Z, e <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location:_ 03 �✓ ��r '� / e4 S? 76 <br /> (Best Physical Description) (City,8r County) Circle One <br /> Date of Discharge: &'-� <br /> Date Notified: / VZ, Time: av P <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: �' u -SA - A10. 7- 02 <br /> Contact Person: Telephone: <br /> Physical Address: 6 ou 1/` ` c �-a - <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: ll,.4 � <br /> Volume: <br /> Chemicals: <br /> Circumstances,:�t�cx61 v <br /> `-- <br /> ,•..L-3-�G`�.cn�c�.t� � C' � •Lr.a��/ls ..L<iiYt•.c <br /> F. ACTION TAKEN . k u'�+ �• %f C�vr �^� ,a� <br /> E <br /> SITE. DISPOSITION c ..-.e .�,.c �✓-��� -/ - � <br /> a <br /> 61 <br /> LUQ <br /> EH 22 013 (Rev.4/91) <br />