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TyK <br /> (, SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> ,a <br /> 1 <br /> A. EMERGENCY LEVEL: (D II IIi LOG # 41 <br /> (Circle One) <br /> B. SOURCE OF INFORMATION PT <br /> Name; M corkL`7 ., Sc�$' Phone: <br /> Company- H K Z In C— 3 am co - - <br /> Address: — ' nsn M�-t�� <br /> Designated Employee Name: ,TERRY YOSHXOKA phone: (Z) 468-0335 <br /> Reporting Agency Name: SAN JOAQUIN COUNTY MWIRONMENTAL HEALTH <br /> Address: 3.4 .. WEBER AVE. <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: <br /> (Best Physical Descnption) Ci r County) Circle One <br /> Date of Discharge: <br /> Date Notified: 3/?S/0T Time: 1-z'? h(n4jd`S <br /> • I <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: T1 7c,- LAIL b Cie- <br /> Contact Person: Telephone: 9!�D cjW-Co900 <br /> Physical Address: <br /> Mailing Address: <br /> F <br /> E. DESCRIPTION <br /> Type of Discharge: -rho -� f <br /> Volume: <br /> Chemicals: <br /> Circumstances: u ' +� k d <br /> F. ACTION TAKEN !5n Gr`G^c�u�d �i t�� IMM <br /> .5 <br /> SITE DISPOSITION �" � - �* - �^ -=w <br /> -r'T� G� Gam- 'v� �c- G ✓� � <br /> :7 <br /> :s <br /> i <br /> EH 22 013 (Rev.4/91) <br />