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` A SAN JOAQUIN COUNTY <br /> NOTIFICATION OF AAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I I1 III PHS-EH LOG nn <br /> (Circle one) <br /> B. SOURCE OF INFORMATION <br /> Name: kmob u.. L�d 0 U u 5 Phone: (fibs)_77716- 16Z o _ <br /> Company: McCw,,,tiaPU <br /> Address: fib. w _d,,}...,lte:s .1k 7�'7 <br /> Designated Employee Name: M..:cJl,•e 1_44- Phone: 'Z6q (,$- <br /> Reporting Agency Name: co , <br /> Address. 3a`( f- W�1ae_ }E,rc <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: u bq b L^)e ` L¢_y,_ - !�� / <br /> (Best Physical Description) itv r County) Circle one <br /> Date of Discharge: <br /> Date Notified: a -La a 3 Time: 1(3 <br /> D. RESPONSIBLE PERSONIBI SINESS <br /> Name of Business: <br /> Contact Person: Phone: Q Z (,-?q- <br /> d2 <br /> Physical Address: qarf 0 [ �„�� �d�c��s� - c A- _ <br /> Mailing Address: {8 30 eY r c;k A-1rL C z rt_co.rd_ C r47_ - Q 41 t 9 <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: <br /> Chemicals: <br /> &,F— <br /> Circumstances:- <br /> F. <br /> ircumstances•F. ACTION TAKEN Ce �s Q <br /> SITE DISPOSITION b <br /> { <br /> EH 22 013 (Rev. 03/20/93) <br />