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.� ry e <br /> U SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL. ,i II III PHS-EH LOG # -D <br /> OCiAle One) ` <br /> B. SOURCE OF INFORMATION <br /> Name: n - Y1 Phone: (-40q) 170- 13 s <br /> Company: k I r c. <br /> Address: 2 V'1 I-6 197f�etU9 Z O S <br /> Designated Employee Name: Phone: �) <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISC GE <br /> Location: 00 �:1F,6 `,+o�t V4 / T:-'( cli' J <br /> (Best Physical Description) (City o County Circle One <br /> Date of Discharge: sil.ki ► <br /> Date Notified: Time: _`O apt <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: -v1r+o( f ) f�S <br /> Contact Person: -P-V er-�2 Telephone: 8-;z) a <br /> Physical Address: _ X2-2_-fl� WC(� r fes <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: in Vn-6�ii <br /> Chemicals: 9,-ese,-( as<p G h <br /> Circumstances: r4 <br /> F: ACTION TAKEN �d+11 ��NY� tQ So,Dt� i SST�� <br /> SITE STATUS � S S <br /> ass���v�.e - 46 e eJrrr f�n e :+h-e �e- <br /> � <br /> fP�u��aru �rn�rnr;� <br /> EH 22 013 (Rev-4/91) <br />