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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180 . 7 <br /> A. EMERGENCY LEVEL: II III 1 ,S;Et LOG <br /> (Circle One) <br /> Be SOURCE OF INFORMATION <br /> Name: Phone: Iti _ _�a51 - !gCl� <br /> Company: d <br /> 27'7 GF W4539 <br /> Address : Q3 Ykvla.i,m.- - �_ )3 • �,rx.sn-t' <br /> Designated Employee Name : Y P one: e�34�2 <br /> Reporting Agency Name : \.�� ( 164ULbi� PAU k //LaZitLiL, u utia w1c5d zL <br /> Address : I L X202 <br /> C. LOCATION AIID DATE ^F ^D•ny <br /> DISCHARGE <br /> Location: 1+04 0 , IMl <br /> (Best Physical Description) Ci or County) Circle One <br /> Date of Discharge : WA141, i ulti- <br /> Date Notified : Time: <br /> D. RESPONSIBLE PERSN/BUSIN SS <br /> Name of Business : 4 <br /> Contact Person: Telep one: 4e�* - sfZQn <br /> Physical Address : 05�Du j, is SQ 95 91 <br /> Mailing Address : 'V"h l31 �SC��lQnt2n CA 4�-c! !o <br /> E. DESCRIPTION <br /> Type of Dischar e : r <br /> Volume : JA , KZUM� <br /> Chemicals : UA lx)Ao <br /> Circ tances : l v d <br /> F. ACTION TAKEN 5AI baAA � o 1��e< L t 44[4' D2t k4A .0 9PIo (] rtctl <br /> SITE DISPOSITION 47D <br /> r <br /> EH 22 013 (Rev.4/91 ) <br />