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1 SAN JOAQUIN COUNTY l ! <br /> NOTIFI�?MON OF HAZARDOUS WASTE DIZ3ARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:© II UI PHS-EH LOG # <br /> (C'ucie One) <br /> B. SOURCE OF INFORMATION <br /> Naive: L i o-r- Phone: (�2 <br /> Company: Rk C2e 4 $ JIG.,, <br /> Address: E. o , P O o O S?a 7dY1 <br /> Designated Employee Name: .v 9< Phone: 3 i72-,v <br /> Reporting Agency Name:-L±M .L, Ga . 6"41,C AE� _ Sg254i ceS- 4 t] <br /> Address: o 0 <br /> C. LOCATION AND DATE OF DISC GE <br /> Location: 9 S RZ r4P <br /> (Best Physical Description) (City or ounty) Circle One <br /> Date of Discharge: UAI*A a-y,n-. <br /> Date Notified: -- 8 Time- a o <br /> D RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: -!;�z✓/C� <br /> Contact Person: uUT Telephone: (292P - - O <br /> Physical Address: 8 7'7 ;,. .- <br /> Mailing Address: • 0 . +3a o -T <br /> E. DESCRIPTION u <br /> Type of Discharge: <br /> Volume: 4 k <br /> Chemicals: 1 c h of vb n.a <br /> Circumstances: G- • <br /> F. ACTION TARNEZe <br /> —76 <br /> SITE DISPOSITION <br /> r^94 <br /> ft�1A�,,� <br /> i Re_ <br /> EH 22 013 (Rev 4/91) <br /> d Nod-=f "V4E l L 666 l- 0-5 <br />