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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL I R III PHS-EH LOG # <br /> de One) <br /> B. SOURCE OF INFORMATION <br /> Name: "Sok I G4--, R,2Pult Z9 4 Phone: 4tt 3 3Z51 <br /> Company: Ken�ed� � �s Lor,s�ti��-t 5 <br /> Address: 5 "33 j28. SLAk-t- Leo LA q 552 <br /> Designated Employee Name: Phone: L� <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: '2- t2 W h i n e✓ <br /> (Best Physical Description) it r County) Circle One <br /> Date of Discharge: V-nouJ v--\ <br /> Date NodHed: S28 �-4 Time: 'S-.30 <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: <br /> Contact Person: RcLv,ctc-U H C-g s Telephone: (� ) 3 33- �a t <br /> Physical Address: <br /> Mailing Address: JP0 6 13 00 Lod: c A <br /> E. DESCRIPTION <br /> Type of Discharge: C V1tor �G�c� h�dv�oce�b o nS <br /> Volume: uy�Y-VAOW Y.% <br /> Chemicals: Cls I Ze� cS�kzroetc �Gllloro�prMr t i C Tricl�lo/o2f1v1S22.�D �'ecinl� <br /> Circumstances: _r^Acv. by5 wo--,6 c-�✓�tl� <br /> F. ACTION TARN U.��s - C � e Ila�-► c�tion wiade o"1 <br /> ��l�t-�p •, 8. 5 9� <br /> SITE STATUS <br /> VWIe &t't0 q5 y"yv,en <br /> EH 22 013 (Rev.4/91) <br />