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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II II PHS-EH LOG # L' C <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: ME Phone: fo &Z)Z-502- <br /> Company: N S <br /> Address: '2401 4n-tg5zC) <br /> Designated Employee Name: Phone: (_) <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: duQ `)U+4-�— / J <br /> (Best Physical Description) City r County) Circle One <br /> Date of Discharge: U'nh(\0\-0, <br /> Date Notified: _1.025 f(4., Time: 15: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: 7o k-4-C r C,<--(Z�c-Q <br /> Contact Person: Telephone: �) <br /> Physical Address: 20 o <br /> Mailing Address: !xw- C / <br /> E. DESCRIPTION <br /> Type of Discharge: yn l4,(10W✓� <br /> Volume: G)A Y--V1C��►� <br /> Chemicals: fro lev✓Vl 1/� Cl c:f�u'1�O.'l S — �- QSD(( ��. <br /> Circumstances: ReJ LCLed Vv/\ 'DS -0rt 5c;uv- (_e l c u tQ G <br /> " �✓v� Ms=���t-Cr<<n� y�� l� y �occx+Cd ost �loy rn of St <br /> 4-- <br /> F. ACTION TAKEN r1 civ' no t-&-j ecA 4- S t c e� <br /> 9,�L �'1� C�✓L tom.v v�c✓�� 5 i-�-� t l <br /> SITS STATUS ��oci wV-( Vy,�c�Q LpesC c <br /> kNA Q l,Me CA ✓ v o-1v,d V'e v-ted <br /> aCaicci r �- S s <br /> 11 r�O,-L . <br /> EH 22 013 (Rev.4/91) <br />