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�..i SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 C <br /> 0 Py <br /> A. EMERGENCY LEVEL411 II III PHS-EH LOG # ��—` / / <br /> (C"ircle One) <br /> B. SOURCE OF INFORMATION <br /> Name:_ At.Nyv 6i6! Phone: <br /> Company: J!iI MOt Ca►Que t&,'i_ <br /> Address: 1hm S ')AoP, . S,)Jrg I?A . 9ASb &)6U L AVE►JE Vt.EMANf tkiO- 0A 04,613 <br /> Designated Employee Name: 'Lkr Phone: (un ) d�'rONS <br /> Reporting Agency Name:im.1hpipai { C'wh&4 f vtwt. S-�dic.K Euy�ruixl&-arm, " NJi5,4 <br /> Address: 45 M) , �M litJ &. 4= PIA g57,01 <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: Z40 P. V tN r / S izx k-w <br /> (Best Physical Desc 'ption) ity r County) Circle One <br /> Date of Discharge: <br /> Date Notified: 4trbtrn[.d Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: <br /> Contact Person: P\Z. Telephone: <br /> Physical Address:Co�-� USA (.,Ml +)zua 4om C PwgGm► ZD ; 6,14 L 0.0.62 L <br /> Mailing Address: ?-D.b - 62,(bl.L--y 6i45f13-c, <br /> E. DESCRIPTION <br /> Type of Discharge: (,.Wv-jubWK) <br /> Volume: <br /> Chemicals: _,sn.k 44,t D0nco., <br /> Circumstances: ?Zhem) (S,<-' (1L-;aL11A?!, n vF toit✓ -?�ajj D6bzj 6A i1 S r <br /> f✓u��11Z-�NtYlt:�-t�1., Pa��LM,EncT <br /> F. ACTION TAKEN LL _?-,.oT nQ�-- 2LMDU�ZTMAmMLM K <br /> 0bjt--Ar 1Pc,- :2k-ZZ�` b CAM -%-JVESIOIS� <br /> SITE STATUS MVVIRpWL-ji) w I) <br /> Pe�gW 44 <br /> EH 22 013 (Rev.4/91) <br />