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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE f _. <br /> 3AF�E'i'Y <br /> _ HEALTH & CO}��+ ) <br /> iir 25180.7 <br /> -•--„ .".-•,..+.amu .. ,.>. <br /> A. EME.gGENCY~L Ir, ..,. . . ..PF S- Lori, <br /> t ' <br /> e.One) <br /> B. SOURCE OF INFORMATION 3- <br /> Name: -fllanne: U” <br /> Designated F.�nployee Name: � a.. _ . <br /> -- <br /> Address: 4 4 s �1l 5•.�. �.w v:.� '�►�� t� �%5 zo,--. <br /> C. LOCATION AND DATE OF DISCHARGE <br /> (Best Physical Description) County) Circle one <br /> Date of Discharge: fie M � <br /> Date Notified: i._I-3- i I-_ Tom:--L=010 '`-r=---- <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: as &ZIC <br /> Contact Person: V•*% Telephone: (34a) <br /> Physical Address: C'% 4 s <br /> Mat-ling Address: o • s <br /> E. DESCRIPTION <br /> Type of Discharge: (� �►�/ or' 4 c ,fir sorXc '' <br /> Volume: �'•, <br /> CircummaanceS: <br /> F. ACTION TAIv w-7_1 z <br /> M 4- <br /> t , <br /> SITE DISPOSITION <br /> EH 22 013 (Rev-4/91) <br />