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U SAN JOAQUIN COUNTY (� <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHAReco HEALTH & SAFETY CODE 25180.7 � J � <br /> lU <br /> A. EMERGENCY LEVEL:�I II III PHS-EH LOG # l <br /> (Circle One) <br /> i <br /> B. SOURCE OF INFORMATION <br /> Name: Phone: <br /> Company: <br /> Address: <br /> Designated Employee Name: Phone: (�) <br /> Reporting Agency Name: Sao �artoo a CCxswmt �w,i�o.kx.d.�a� i roil �iivis�u.� <br /> Address: -')b4 63---br--v- STvLr- 457A I <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: Z-10I UAACI L LN <br /> (Best Physical Description) or County) Circle One <br /> Date of Discharge: l0 Z3 4S <br /> Date Notified: io.z3 5`' Time: 1 4rei <br /> — J <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: U kltr� -�t 5N <br /> Contact Person: P—bw rtoz--, 0A,-gnm--� Telephone: Sco -»n - 2,5( k <br /> Physical Address: 7,c t C �,¢aCPQ. Ch) ?� we 5m4CO 5tw ohm v.1 [a G l5k4 <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: U U a ,J Mt3su � Z�t�ps� <br /> Volume: U uY 4,wr3 <br /> Chemicals: t)t r3eL- -C) A At9 <br /> Circumstances: e:*cjay A-G' <br /> EnULek,E^-Z AVnJc�mc:2> C)lc3OzT�t4- WLD( <br /> L-Q 1 Al-)J�i'E w P�'Q t o 1-3',q/K l.J ttt k-a ?11*5RA-z'L�4 F-c '(Tb..IC. It c--V W A--- <br /> F. ACTION TAKEN -fM C4VIC NXg ?UMPE> Tp r� mpbYLnlW s�m�2i3 r7anc- <br /> �jJ'nnt✓YL <br /> i <br /> SITE DISPOSITION �/0t� z7m( , 4(;6a6tW--n>C Tn �ra�alm C� <br /> EH 22 013 (Rev.4/91) <br />