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C <br /> ' SAN JOAQUIN COUNTY`` . <br /> NOTIFA4'ION OF HAZARDOUS WASTE 064AARGLit <br /> s <br /> HEALTH & SAFETY CODE 25180.7 <br /> S.i <br /> A. EMERGENCY LEVEL'- III PHS-EH LOG <br /> (Circle One) <br /> B. SOURCE OF INFORMATION ?! <br /> Name: Phone: ' <br /> Company: S �- <br /> Address: 114ff O fe <br /> Designated Employee Name: 4 ` e. Phone: ( L t <br /> Reporting Agency Name:—LA i - � N4 U k iii L. <br /> Address: <br /> C. LOCATION AND DAT OF DISCHARGE <br /> Location: 2 ZU - � � s✓Tr�e . , ,., / X/1" <br /> (Best Physical Description) (City County) Circle One <br /> Date of Discharge. .max <br /> Date Notified; _- --/--Z1 � Time:—_-- _ 74 "1 <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: SII 1-r <br /> Contact Person:- Telephone: O <br /> Physical Address., <br /> 3 G <br /> Mailing Address: , -_�, �� DC7 �Tc� 5 .r? <br /> _ F <br /> E. DESCRIPTION <br /> Type of Discharge: U <br /> Volume: l I t1i kvvi"A)► #¢ <br /> Chemicals: , e. ,e, o(v-G.c_�►2-1i ori <br /> Circumstances: 5--00-0 i 5',z . ►-� ^ <br /> I'. ACTION TAKEN �C L b2.e ti. _. . A- _ <br /> W 1A 14 +ke I . cry r-ti G <br /> SITE DISPOSITION5 Gk ,'L <br /> 5 qoA IA.r &0, �� ►^Cam e . <br /> I. <br /> EI-1 22 013 (Rev.4/91) <br />