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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 # <br /> 'I cle One) <br /> B. SOURCE OF INFORMATION <br /> None. a <br /> L' Phone: <br /> N �. <br /> Company: - <br /> Address• t i _ �' 4��� �' <br /> Designated Employee Name: . t~I— A n.% -St4N-J t Phone: y '3 <br /> Reporting Agency Name: i•~ ArfeDI V' <br /> Address•_., o t2 <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: —0 S Wi , <br /> (Best'Physical Des, ption) (Cityr C ty Cirde One <br /> Date of Discharge: L4 <br /> Date Notified•i I Time: S'; dfA <br /> D. RESPONSIBLE PERSON/BUS�SS <br /> Name of Business: c.,. 5 -nlr�-t�Y <br /> f <br /> Contact Person: 0 r• Lv Q 1 elephone: <br /> Physical Address: —7-5-27-57- �i 7 <br /> Malluig Addre55. b 8 0?t r <br /> E. DESCRIPTION <br /> Type of discharge: <br /> Volume: K <br /> Chemicals: -Fri ) a <br /> Circumstances= a so i -e s <br /> F. ACTION TAKEN ?J <br /> I' f% <br /> !I ' <br /> SITE DISPOSITION 2. Q <br /> �4 'i R <br /> L Z G' � <br /> EH 22 013 (Rev.4/91) <br />