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Sar JOAQLT N COUNTY <br /> NOTIFICATION OF gAZARDOUS WASTE DISC$-kRGE FILE COPY <br /> E E_-_LTH & SAFETY CODE 25130.1 <br /> A. EMERGENCY LEVEL:0II III PHS-EH LOG.13 99 2 2 <br /> (Circle one) <br /> B. SOLRCEOF INF02�LATION <br /> Name: Jl c�GE ? v[ '~ Phone: ( ) <br /> Company <br /> Address: <br /> Designated Employee`ame: �i; G ti �c�2h Phone: 2jT CIS! ��a3 '1 <br /> Reporting .agency Name: <br /> Address:-3p4- e, vur Izer 5yiR4 t <br /> C. LOCATION A,LID DATE OF DISCHARGE <br /> Location: <br /> (Best Physicai Description) ( or County) Cirete one <br /> Date of Discharge: " I t 0 1 c ` Time: I <br /> Date Notified: Q <br /> D. RESPONSIBLE PERSON"Bt;SINI A ESSS^ <br /> Name Or Business:.F] ct) t 1 `/eM <br /> Contact P_rson: Phone. <br /> C C1 <br /> Physical .address: i ttJ >a <br /> 7 /.,�> 9 <br /> Mailing Address: .Tv C; , r <br /> ti7h <br /> E. DESCRIPTION <br /> Type of Discharge: 5� t I"`G�C L2r k c ,� I •" " - 6 Z_e, <br /> Volume: U l <br /> Chemicals: <br /> Circumstanc j t LtcA Cl'✓ ;Zrz F Af c tr�u <br /> F. ACTION TAKEN 5; ` ( <br /> SITE DISPOSITION <br /> EH 22 0l= I.Rcv. 03%20/93) <br />