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SAN JOAQUIN COUNTY <br /> NOTIFI(-ATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180 <br /> cupy <br /> A. EMERGENCY LEVEL: II III PHS-EH LOG # <br /> (circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: 1-40 0�ac.c.Ts G NG s Phone: qi✓ <br /> Company: <br /> Address: �P-S G d Z-ltJ t C <br /> Designated Employee Name: Phone: <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 353�o E. IWIVe5e 5reeE7- <br /> (Best Physical Description) ' itv or County) Circle One <br /> Date of Discharge: //A/,< <br /> Date Notified: 7-30 —Y/ Time: /Z iyco�1 <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: O Y-5 4a7Z) CUREe r�,✓G <br /> Contact Person: f0 Y AWOL-L- Telephone: (4LD V6 <br /> Physical Address: 3577-C E /17in/ C'.4 . SaOS <br /> Mailing Address: ae,�� /&16L-d L zy D�, 9�6Li <br /> E. DESCRIPTION C� <br /> Type of Discharge: � LL,, E iSpos�4-L_ <br /> Volume: Un/X <br /> Chemicals: _ �d//Lv�nfT, /XorD2 G`c6�, OiG ,LE,� <br /> Circumstances: GNv<20r�nr�scJTi}-L �4$s� IS7101c- 3o� us.s <br /> F. ACTION TAKEN_ Ale) XCT e AI <br /> 01 <br /> a- <br /> SITE DISPOSITION y4, i4�s, cc/,�GtJQ CSB. <br /> EH 22 013 (Rev.4/91) <br />