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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHA <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEI I III PHS-EH LOG# aC7 <br /> crc[e one) <br /> B. SOURCE OF INFORMATION <br /> Name: & 6ev f LC7 e F_ Phone: <br /> Company:SGL Q' -S <br /> Address: r- RyV1 Q S Lj_ZL) <br /> Designated Employee Name: 1 Phone: - <br /> Reporting Agency Name: _ �/{ pI V l <br /> Address: ADL} �.�(VQ, �I/ }�YP1i�1.t.ij�T�Vi l V� �[DOI� 5tLYj�fi�✓� <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 14100 e, F—r-eyy1o✓Lt ck_+Z�-VL <br /> (Best Physical Description) (City o County Circle on; <br /> Date of Discharge: <br /> OlAf R0 2-0Q2 <br /> Date Notified: Time: )D`dQAM <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: C�1!eM 'k'c" C-0S C L�G� uor _ <br /> Contact Person: Phone: <br /> Physical Address: i4VY1 p <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: GU,UJ1A <br /> VOIUme: '1 1/1 <br /> Chemicals: I✓ _ IlAiy! <br /> Circumstanc lip` Vl � C CA <br /> F. ACTION TAKEN L G VU + l <br /> 1Ea. <br /> SITE DISPOSIT ON Cs <br /> SP Inds, <br /> EH 22 013 (Rev. 08/20/98) <br />