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SAN JOAQUIN COUNTY <br /> NQTIFFCATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH.& SAFETY CODE 25180.7 <br /> A- EMERGENCY LEVEL: I II II PHS-EH LOG # . <br /> h (Circle One) <br /> B. SOURCE OF FNFORMATFON <br /> Name: Phone: (� <br /> Company: f n <br /> Address: <br /> Designated Employee Name: /G / .PSS Phone: �) <br /> Reporting Agency Name- �n/ uw E.rlr� "t7- 011. <br /> Address: 41 �laQ ! <br /> C. LOCATION AND Dtt��TE OF Di CH.A.F�GE _ k <br /> Location: ZZSfi S <br /> (Best Physical Description) _. _ riCity r County) Circle One <br /> Date of Discharge: ' 1/4it'NOuJit/ ' <br /> Date Notified: l/• /Z-• ?Q Time: <br /> D. RESPONSIBLE PERSON/BUSINESS ✓ J ; •.; <br /> Name Of Business: U! STt�� .51'b111� 9 <br /> >i; <br /> rr. <br /> Contact Person: Telephone: Sia 657 Soo <br /> Physical Address: <br /> Mailing Address: Com- <br /> E. DESCRIPTION <br /> Type of Disc�iarge: 4V i <br /> Volume: O <br /> Chemicals: g6&JOW <br /> Circumstances: Bbo A0 /4 <br /> Sol A C- <br /> F. <br /> F. ACTION TAKEN : ",— U <br /> �r C.�/ieltJQ CA /*'wec_S <br /> SITE STATUS - -5iTE /A/ r 7 4 �.s�6 ^/mow (/ 040K ice. <br /> r h <br /> IAAKC <br /> EH 22 013 (Rev.4/91) <br />