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SAN JOAQUIN COUNTY <br /> NOTIFICATION`OF HAZARDOUS WASTE DISCHARG <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: 1 ;iII III PHS-EH LOG # <br /> -9-7- <br /> (Circle One) <br /> B. SOURC OF INFORMATION "�, F� <br /> Name: i Phone: <br /> Company. ; <br /> Address: ft D E-t-IJ C /3 <br /> Designated Employee Name: 11 Al" �G phone: C__7 <br /> t Reporting Agency Name: 'fP <br /> i Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location:_ 7k:)O W. �iu.v iE .Pa! — / ,.'✓ <br /> (Best Physical Description) (City oro ty) Circle One <br /> Date of Discharge: <br /> Date Notified: _ f13 !?-7 Time: <br /> D. i RESPONSIBLE PERS /BUSINESS <br /> Name of Business: ctdEt} i" /7 cuLrua2 �.0 sTi*&,rrS <br /> Contact Person: N i Telephone: &4 • 3?�Z,. <br /> Physical Address: .'fI " p �'' old C,4 Zcn <br /> Mailing Address: <br /> E. DESCRIPTION - <br /> Type of Discharge: ill &bAl'.. r <br /> 4 Volume: <br /> �V .h <br /> Chemicals: e— <br /> Circumstances: etC5U7,-' :!5aa .5 Sof C_ av�t1 t!/ <br /> 1 50, c. v <br /> F. ' ACTION TAKEN <br /> t461 <br /> N <br /> n <br /> 5� GE -t 71e ➢`a <br /> VdGv,� /Arlb *e— ©UcSrsicsr�� <br /> SITE STATUS NaT' 'Z*41— 6C <br /> F D e-= <br /> 1 ,y. <br /> 7 r <br /> S <br /> EH 22; 013 (Rev.4/91) .w <br />