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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WAS'T'E DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 , Li <br /> U <br /> A. EMERGENCY LEVEL:(f�ft III PHS-EH LOG # 1-5 <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: 2`c ` -oS/4S'o 144 Phone: <br /> Company: 6F. S . <br /> Address: 22Z c-vv 14 <br /> Designated Employee Name: Phone: <br /> Reporting Agency Name: <br /> Address: cPv`-' s`�� Sri <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 7 7 U v /`r4-1,,0-7— / s%�,o A <br /> (Best Physical D cri 'on) Caw County) Circle One <br /> Date of Discharge: 3 9 <br /> Date Notified: 6 Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: Q <br /> Contact Person: GY Telephone: 4731- 55` <br /> Physical Address: 77 06> — b <br /> Mailing Address: o• 12 ox- o e2 co c ` Z` <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> volume: -1 -3 b N <br /> Chemicals: <br /> Circumstances: S,o�6G 4vr/S c*ie2�- <br /> F. ACTION TAKEN <br /> A�--z� i'J.Q�vE cF,C occv �� <br /> SITE DISPOSITION 51-') LEW <br /> /n3�er�4��T1✓� /���� 1�-s�I.-9 ���1�� Gl..r�.�,e �ieoGE� <br /> SSR L - <br /> EH 22 013 (Rev.4/91) <br />