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r <br /> r �Q� <br /> �6 SAN JOAQUIN COUNTY <br /> {l. p� L� OTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> -1 L <br /> A. EMERGENCY LEVEL: II III PHS-EH LOG # <br /> (C'ircle One) <br /> B. SOURCE OF INFORMATION <br /> Name: A1.Nu i�i h Phone: <br /> Company: IW6 MAf t �i2i1�,p tti�i <br /> Address: tU PhKY,1L Av euj9L0'5AXf OA G�St3 <br /> Designated Employee Name: ,?,w Qati,-e, Phone: C7�) 1o4'r D3�42 <br /> Reporting Agency Name:jAd-)Qg0111Ai-VWA&1 f ueMl rh-VU'A i-�� FUu,n..'KJ MKI , kllM N 5idA)4 <br /> Address: 0GAfj 3Athlit') i"r1A G� 1�1 <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location:_ Fl. WhAj <br /> (Best Physical Desc ' tion) iry r County) Circle One <br /> Date of Discharge: <br /> Date Notified: n , Time:_ <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: <br /> Contact Person: 4AZ. awl Teleph e: (56 ) zo - r I qL <br /> Physical Address: Ci , 'Zp k 14 <br /> Mailing Address: w4 � <br /> E. DESCRIPTION <br /> Type of Discharge: I �NI�nfDWh� <br /> Volume: _j (3 <br /> Chemicals: Oe I kk 44'4 DOnc.A?&��nr, <br /> Circumstances: ?_Aljdv (1`FIt 6r- SNIc_ �n� <br /> t✓1J��12 D nim t. M6h--!6nit FLET <br /> F. ACTION TARN )S..tk P,uT ho, -- l)Si 7��nl�(�'11 . "V5Q,1Trl Di l7iirL <br /> �bT�^AIC�Pc�_. T7� Y,��_�1�iSi�'gJflL�ls��.� hJPi�TL. fir- �.r�C � 7�CJ�LoO <br /> 'S Pume /a 4,o5C"b <br /> SITE STATUS +R\) j4+y J <br /> CAI C/b <br /> EH 22 013 (Rev-4/91) <br />