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SAN JOAQ UIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE a �-- <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:(T�kI III y PHS-EH LOG <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Phone: �) <br /> Company: <br /> Address <br /> Designated Employee Name: 57 ccio,, Phone: ClEt3 y6 <br /> Reporting Agency Name: &� C.a• 5 - l�p <br /> Address: L/Lls ;l . Sc1 �c,oc� v��► S ?Yx ��c�r (., S�SZor <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: ' z Z7 Z Z -5. /4Ajv ni / .1�0e7 <br /> (Best Physical Description) (City or County) Circle One <br /> Date of Discharge: <br /> Date Notified: 5 7 z y r` i Time: 3:ocDe n+ . <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: ,\,,, c o Trj C — <br /> Contact Person:- C. %0" nc,�'N Telephone: los 5;9s zdr z <br /> Physical Address: z z-7 i <br /> Mailing Address: pI me- d;k Co. z6O Mtr-\Ae1t- <br /> C`- g yrs 40 <br /> E. DESCRIPTION <br /> Type of Discharge: l�/�• <br /> Volume: <br /> Chemicals: S G / <br /> Circumstances: macJ/".7 <br /> F. ACTION TAKEN .41 AJC. i <br /> ^��• /.K .i� r� ilD 'ce r✓.3 sSvlo/ -/tic <br /> SITE DIS1POS((ITION <br /> irrr►��i� �'ibrl ,r)r�/'awl /�✓/THS/ `O//y(oS��•4 //O.�LL �✓.•/� ' /�-c <br /> ��i� S���✓ �v .�P Yi.rli�r1G 7L/7� ext�17— � �G <br /> /_•/n/1 �rA,l A a �/�r1 <br /> EH 22 013 (Rev.4/91) <br />