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• 0 �t- <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHEECOPY <br /> /�H\EALTH & SAFETY CODE ?5180.i c <br /> A. EMERGENCY LEVE I(: I/II PHS-EH LOG <br /> ircle one) <br /> B. SOURCE OF INNFORrMATION <br /> Name: _ S • X �� AJ Phone: (� �� 0 o3ss <br /> Company: S , PKS Cfd <br /> Address: v v1I e r <br /> Designated Employee Name: A 5 /�F30U'✓ Phone: <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE L I' <br /> ✓ Location: :2)q3 <br /> (Best Physical Description) (City or County) Circle one <br /> Date of Discharge: ldl k�0 <br /> Date Notified: i 9 /9 9 Time: 0 <br /> D. RESPONSIBLE PERSON/BUSINESS / <br /> Name of Business: C7! t( � 5 Tru C F/ <br /> Contact Person: lie 5 ?hone: <br /> Physical Address: y�Os <br /> Mailing address: P� Q, OX 6�t 3 S Yo c k an <br /> E. DESCRIP'ITON leak ul/1 aG/Or�`2P <br /> Type of Discharge: <br /> w�(/+ <br /> Volume: 70'`�'� <br /> Chemicals: 6 <br /> Circumstances: z2 A C a �iov� <br /> duck G <br /> F. AC Gadd ^9 c��lkckUlaS�al� 0. A ee �rc», <br /> N S O�� f rr� /Yn 9n n ✓ey '✓Q� <br /> 9 ro <br /> SITE DISPOSITION S(�/l �� l l4� i4 G�G'tn <br /> EH '__ 013 (Rev. 08120/93) <br />