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SAN JOAQUIN COUNTY <br /> y NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH' & SAFETY CODE 25180.7 ' <br /> oo,.4. <br /> A. EMERGENCY LEVEL: II III PHS-EH LOG # <br /> (Circle One) <br /> k <br /> a <br /> B. SOURCE OF INFORMATION � oil <br /> Name: AP--r 6r57re4 D. E. S _ - - A Phone: ( (-3yv/Zi <br /> Company: d, 4S'• :; I <br /> Address: <br /> Designated Employee Name: - ✓ <br /> Phone: ` —o33� <br /> Reporting Agency Name: '` %a Ca&( /,/AAA x4J G" <br /> Address: a , 65 a)e 2a <br /> C. LOCATION AND DATE OF DISCW' GE <br /> Location: e / /yI f CIA <br /> (Best Physical Description) (City or dunty) Circle One <br /> Date of Discharge: <br /> Date Notified: Time: lZ•'/ <br /> D. RESPONSIBLE PERSON/BUSINESS i 1 <br /> Name of Business: <br /> Contact Person: Ro 1/ 6kn/6 A0 s _ A go-r Civ ir-:Telephone: 9-3 <br /> Physical Address: 1--V6 t Ma c u ! <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: __VIUA-UP,,ob .;7d 4&A Sz, -- <br /> Volume: OA)Kn o k,;,) k <br /> Chemicals: A � <br /> Circumstances: Lr,jr LeA)<- LA.L,, PSS oV-e 10 I <br /> p-5 e,f '+P-N K <br /> F. ACTION TAKEN 1 I� hn.a L eJ A� - <br /> `rCo - � <br /> t= �(a2 6 ��14 Pro r--, r-z <br /> ctT`D r v , <br /> / c r _ <br /> i <br /> SITE DISPOSITION l 1'� �, �vP r� fi=r ,___ 5Q::Q 2J � # <br /> 60 Al to N' 6se"e.d <br /> s e Diss X55 w <br /> be, <br /> x ed r "aVF ✓ r <br /> } <br /> . f <br /> { <br /> E <br /> EH 22 013 (Rev.4/91) <br />