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'° K c�c SAN JOAQUIN COUNTY X <br /> ��� IRONMENTAL HEALTH DEPARi—ENT /r� r U) <br /> .:• �, � tockton, CA 95202-2708 <br /> :4 (209)468-3420 •Fax:(209)464-0138 • Web: v ww.co.san-joaquin.ca.us/ehd <br /> C FpR� <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> California Health & Safety Code. Section 25180.7 <br /> EHD LOG #: 0 7 <br /> A. EMERGENCY LEVEL: II IIT <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: 'Ta 4 Phone: CC!) ?,46,- A <br /> Company: 5POtL61 bafio � m., g _ <br /> Address: City: Zip Code: <br /> Designated Employee Name: <br /> Reporting Agency Name: <br /> Address: City: Zip Code: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: L-D r t 4 k v, ai� r County <br /> (Best Physical Description (Circle One) <br /> Date of Discharge: « l b(D _ Date Notified: 16 l �G�7 Time: ;S"] AD P.M. <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: A 4�>- fi E . <br /> Contact Person: /✓ `r )Ae-( X— L� Phone: rte;) 60 o3,2 <br /> Physical Address: City. Zip Code: <br /> Mailing Address: 6K City: 12 56'Pb r/ Zip Code: <br /> E. DESCRIPTION <br /> Type of Discharge: �G - <br /> Volume: A� _ �i�� �j It&-I( _ <br /> Chemicals: 7"r a ,,1 Lo r, to a` 61 <br /> Circumstances: '� LS�aL, (�-� n r t-S 41 N.� <br /> x.11. P... (-i hf (/- fUT�^Cnr+,,c= 4/-ell n <br /> F. ACTION TAKEN: - <br /> - r"i <br /> SITE DISPOSITION: C i f, G. <br /> EHD 224p2-00_ Notification:o1 Haz Discharge <br /> i 0/2'200 <br />