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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARrm— <br /> HEALTH & SAFETY CODE 25180.7 C(a Fly <br /> A. EMERGENCY LEVE II III PHS-EH LOG # <br /> ( ircle One) <br /> B. SOURCE OF INFORMATION <br /> Name: I l� .e u_�-�./- Phone: a o9 <br /> Company: ' "a C <br /> Address: r--;,3 <br /> Designated Employe Name: Cc, / 00 Phone: (2La) c(n <br /> Reporting AgencyName: S,; 62 4? <br /> Address: e(—Ys— v, <br /> C. LOCATION ANDD TE OF DISCHARGE <br /> Location: I f a 1 was GP,7�o / /c/z, <br /> rd <br /> (Best Physical Description) i®r County) Circle One <br /> Date of Discharge: lc ,I vJ,� <br /> Date Notified: Time: a <br /> D. RESPONSIBLE PE ON/BUSINESS <br /> Name of Business: 0 c v�� <br /> Contact Person: << s Telephone: CaZo !2 v,� <br /> Physical Address: <br /> Mailing Address: i IC,, Yl0/ d= 7 <br /> E. DESCRIPTION <br /> Type of Discharge: Q v <br /> Volume: u E„ ,ter u ,r /-cv -1p <br /> Chemicals: i C 5 !e o cle 6, f U t� <br /> Circumstances: ,: ev�� All <br /> F. ACTION TAKEN C Lceai Z L <br /> SITE DISPOSITION _ ., k� s s u:� N / 9/h <br /> ao Lw u e� n 64, S i v <br /> 'CY Lt /G✓ 7 `t � <br /> EH 22 013 (Rev.4/91) <br />