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IL t� _ <br /> 1 SAN JOAQUIN COUNTY U T <br /> NOTIFICN11ON OF HAZARDOUS WASTE DISCHARGE U <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: 1 II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: co Phone: Ci l) <br /> Company: <br /> I Address: v �ivr�o L.J 7Q����v�r <br /> Designated Employee Name: am 4Z Phone: ( 4�k�3r;/20 <br /> Reporting Agency Name: e ,1) <br /> Address': .O <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: ! Q •C7�,G -y�2�� <br /> (Best Physical Description) .(City or.Countyl Circle One <br /> Date of Discharge: vz471WAJ <br /> Date Notified: Z% - / Time: . ora <br /> D. RESPONSIBLE PERSON BUSINESS //'�_ <br /> Name of Business: r4 eek � (_ [.. 6(t� I <br /> Contact Person:- �r Go r$PS Telephone: ? S <br /> Physical Address: ate , 2� �� G 31 <br /> Mailing Address: 9� <br /> E. DESCRIPTION ! <br /> Type of,Discharge: <br /> Volume: Al G� <br /> Chemicals: <br /> Circumstances: galaf ' <br /> F. ACTION TAKEN &el <br /> r� e ✓ o44J <br /> rLAW <br /> � ice►� <br /> i <br /> SITE DISPOSITION <br /> EH 22 013 (Rev.4/91) <br />