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110:ABAM FROM P. 2 <br /> � . <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE JUL 6 19% o <br /> } HEALTH & SAFETY CODE 25180.7 <br /> v <br /> a '7"ES <br /> A. EMERGENCY LEVEL: I III PHS-EH LOG # + 103 <br /> " 3 <br /> ( cle One) <br /> L <br /> B. SOURCE OF INFORMATION <br /> Name: y GFGGoj Phone: U a,�—v33Z <br /> Company: <br /> i Address- <br /> Designated Employee Name: Phone: L� <br /> Reporting Agency Name: <br /> Address: _ '5a<-/ 6. W,���/4 v� . TA'Al =— S-rw- k=-, <br /> C. LOCATION AND DATE OF D SCHARGE <br /> Location �L '7 s1 / r- Waft IZ GC6-,0—'4T�i <br /> (Best Physical Description) (City or ) Circle One <br /> Date of Discharge: Y�ra. . ,,I <br /> Date Nodfied: _7 f99l _ •Tbue: 7 <br /> L D. RESPONSIBLE PE'RSON/BUSD4ESS <br /> Name of Business: ._ v. k <br /> Contact Person:- {� k- Telcchone: <br /> Physical Address - /-. — <br /> Mailing Address: v- k-. <br /> E. DESCRIPTION <br /> Type of Discharge: Possr 6 a- .ee6s,s,�- <br /> Volume• 1 <br /> Chemicals' uJ�.r u s A^ G.A7 w rd-r. fled4vcro of �.Errl <br /> Circumstances: rSfS- ,E fwo .Y er a PSI x5cvcv< <-6 kgel 7rccot-C�.c�/� <br /> L3%�1rSa vE sS 9 <br /> LF. ACTION TAKEN_Qi-c—k <br /> 04 FJ r/LI raPl�daC �iA S:/:L nkllrGcf� <br /> L <br /> SITE DISPOSITION :�v�-:,eE -7r, <br /> Lccr�l. <br /> r� .a.�ry�_ 6h .a.��6CE �g •uc d.t 5aG ;e P <br /> L --ri ��a.v_'ui7Y�ATE S�sS�L��-4 <br /> } <br /> EH 22 013 (Rev.4/91) <br /> L v <br />