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SAN JOAQUIN COUNTY ' <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE Cap <br /> HEALTH & SAFETY CODE 25180.7 <br /> I <br /> A. EMERGENCY LEVEL: 1 11 III PHS-EH LOG # D �a <br /> (Circle One) ' <br /> B. SOURCE OF INFORMATION <br /> Name: amu Phone: (j/ 5ao�1Gy <br /> Company: to <br /> Address: SDS/ 5 a <br /> Designated Employee Name: Phone: (_) <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: /56/5 �- SEVE>vTtf sl / P <br /> . (Best Physical Description) City or County) Circle One <br /> Date of Discharge: zl1V.(�n/D1,dW <br /> Date Notified: SLY 93 Time: Pall. <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: 1,1fFiV957Dn/S 4e6 /1/„yi /d�i42KET <br /> Contact Person: Rk. #me5 L.4las n/ Telephone: V4D ?vim? .'-C/-AO <br /> Physical Address: /S6/S s. sE✓E.yrH 57-, L, ,,7� 04 <br /> Mailing Address: P.O. /304_9 L �L 95334 <br /> - 1 <br /> E. DESCRIPTION <br /> Type of Discharge: U/1Y$o>/O.e/1Ai 16zei 5-r <br /> Volume: uAx,VoWV <br /> Chemicals: fl c T <br /> Circumstances: 6�vr ed 4s7- <br /> F. <br /> sTF. ACTION TAKEN:G) .51J6uT 's ov*TEb S1 <br /> �ciur c iy:Ny c E <br /> 6,7' !�i✓p79rx��,�liSrU di/G�,Ee <br /> i <br /> SITE DISPOSITION i rite 2Lo �. <br /> .ao�Ce <br /> EH 22 013 (Rev.4/91) <br /> '*000"t"7_ <br />