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II , SAN JOAQUIN COUNTY <br /> NOTIFICION OF HAZARDOUS WASTE DI! y © [Py <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: LIQ tI III PHS EH LOG # Z <br /> (Circle One) <br /> B. SOURCE OF INFORMATION phone: (¢l5) S`1 ' 4 <br />` Name C� E <br /> Company �- <br /> Address fM(,.-Eclkai ��N �} <br /> Designated Employee Name: Phone: (_) <br /> Reporting Agency Name: <br /> Address: <br /> i <br /> j C. LOCATION ANDS A�rEOF DI CHARGE <br /> Location: 3 7S5 4j AVAYO 6y,-, I-kt-1 r— / �ZtuC+'by� s" <br /> (Best Physical Des ption) (City or County) Circle One Ei <br /> Date of Discharge: 14 n <br /> Date Notified: "1 2q 5 1) Time: <br /> L — - <br /> r. <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: elzoto <br /> Contact Person: gvPA �C girl- Telephone: (,AIS) !vim 7 <br /> .1L C(U -SSCO ' <br /> Physical Address: 4-6.o-f Cr- <br /> Mailing <br /> Mailing Address: <br /> E. DESCRIPTION <br /> f Type of Discharge: ISN —}erZR+ 1 <br /> Volume: <br /> Chemicals: <br /> i <br /> Circumstances: <br /> F. ACTION TAKEN D, l.lt�'vcE, — <br /> am Ric Cvt1 i �e 'sA :T�C� Lkr �:wS (Zr\ i� Cn tTt�rri rarer sv.,— <br /> -5n-QA GYf •-T, %<, SIM r' . 'SHir Q.sf�It�i�1 i. nc- <br /> -r,�L,f r�,(Lf�in.S t7!`J�m� r.wt al2s��'1�N-cX3tiul� A -rb <br /> a . G- P, <br /> I SITE DISPOSITION --MS krc�CiF.1+t-k <br /> r . :,Gka� S''P4� CSY�G�SI'Ylt.ti`�Yf't�"✓� !tu2e�2, 'd1��S� 'I�ru'(Z- gK"P(.-P[.,^yY�s<_N� <br /> F Q1rCa✓� 61 \`j QA-�.Qb'�..'•TL�1 P2T�L f �tKL�1sC �ti.l$t� �31� <br /> 1 a ewit F� C�I- 2 ram Sn�i� Ft: 2, _� ry f 5��✓�� 1211 <br /> P.r n, t. azl C� �S S � C�/LcSu+ iLl7r�� t t�L N'3lzl� <br /> Pug <br /> EH 22 013 (Rev.4/91) <br />