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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: 111 III PHS-EH LOG # C1 D <br /> ( ircle One) �^ <br /> B. SOURCE OF INFORMATION <br /> Name: Dolma+ Alt5vP Phone: ( ) �5Z- O'�Qd <br /> Company: G�,._.4-ra..L4 4-'c�Q L-a,�2o-a. <br /> Address: 10-31 k 5 s _ N47. �v C a <br /> Designated Employee Name: Phone: <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location:_ 1 L401 W • Fri / <br /> (Best Physical Description) ( i ' r County) Circle One <br /> Date of Discharger <br /> Date Notified: (o .2- Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: U�b4hzll� <br /> Contact Person: Telephone: (476)_ -nal <br /> Physical Address: j t-I Q 1 1,0 63 52-o <br /> Mailing Address: � - <br /> E. DESCRIPTION _ <br /> Type of Discharge: &k- Cu✓t S <br /> Volume: <br /> Chemicals: _T <br /> Circumstances: Y <br /> F. ACTION TAKEN ` <br /> y <br /> SITE STATUS VC5 r <br /> f ' <br /> E1-1 22 013 (Rev-4/91) <br />