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P� <br /> • SAN JOAQ UIN COUNTY 0 <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 Q <br /> CC <br /> A. EMERGENCY LEVEL:01 II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORM TION <br /> Y o Phone: <br /> Name: <br /> Company: Gi v o <br /> Address: <br /> Designated Employee Name: Phone: �) <br /> Reporting Agency N e. <br /> Address: �/�/� SW� 4-)UrS'T <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: elr-1oo � <br /> (Best Physical Description) (C`ior County) Circle One <br /> Date of Discharge: S`5 F5 <br /> Date Notified: S/��S T e: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: G's�c�,2o yD <br /> Contact Person: Y Telephone: /D 9-/Z-10:M <br /> Physical Address: <br /> Mailing Address: o eX.moo <br /> E. DESCRIPTION <br /> Type of Discharge: v�A �'i��2i � <br /> Volume: <br /> Chemicals: e—x9:!ee,,MkSoc <br /> Circumstances: icQr�Y r ''ems ?'a <br /> F. ACTION TAKEN 1771/ <br /> SITE STATUS G�,2 s Sc' T ?'o •7- <br /> �-i T VoG i.-r <br /> mac.riecr/J °h- -fir �9 .d Ole- <br /> EH <br /> 2EH 22 013 (Rev.4/91) <br />