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N I <br /> - -h LL <br /> SAN JOAQUIN COUNTY <br /> NOTIFIC e0N OF HAZARDOUS WASTE DISCHARGE I <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: /II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION } <br /> Name: C7 vclt. Phone: <br /> Company:_!'�c�r <br /> Address: �G%vz; -� �vi'Gu �� S'i���.�'� I G• 1��i <br /> Designated Employee Name: F'rc� r,F' ;�r'�.��:I- Phone: �� 7 �Gss-6'.33.2 <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location- <br /> •(Best Physical Description) ' mit or County) Circle One <br /> Date of Discharge: ,..= <br /> Date Notified: Time:_�j- 3 c4"f _ <br /> i <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: <br /> Contact Person: Telephone: �'� 3,& <br /> Physical Address: <br /> Mailing Address: P� •fir ti �p G`o s�:y %. �'��.' 1 �. <br /> E. DESCRIPTION i <br /> Type of Discharge: <br /> Volume: 6.- <br /> Chemicals: u•.c/ <br /> Chemicals: <br /> Circumstances: c E+rrr'& v j= Sore 14G <br /> F. ACTION TAKEN :�n���P-Cv,lfi l c 7G � •r %r�r,l S f`��"�y� Iii r'•l <br /> G <br /> SITE DISPOSITION /% S . �h-�Q.ui�l�L�'�cr J �c-rG�- <br /> �����a'�S% .���.c'�{E/`'�. ��yc'�T/Erd iro.✓ <f n!_�.J _i2��'�}���L i�r`/ s <br /> �.�d-sem /'�F .e�ri��,zc�� i3Y ���_���i�,/.•�� � y �'- 4� Q G� - .� <br /> I <br /> EH 22 013 (Rev.4/91) <br />