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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:(Da III AHS-EH LOG <br /> (Circle One) <br /> B. SOURCE OF'.INFORMATION <br /> Name: U 1I tawt Lvk41r-- Phone: �) <br /> Company: k\C-4\,eay-�ce_ G�c, �v,ti; �,'':�,��+�1 <br /> Address: i Boa N(Car-dn L-n nc_- <br /> Designated Employee Name: Jerry Yoshioka phone: 20'3 468--0335 <br /> Reporting Agency Name: Public Health Services - Envizo=ental Health Divison <br /> Address: 304 E- Weber Ave. , Stockton, CA 95202 <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 576 0 y <br /> (Best Physical Description) County) Circle One <br /> Dare of Discharge: <br /> Date Notified: i ( 5/Ps Time: V-),- <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: j,:A Ces- +cr <br /> Contact Person:- Telephone: �) 31�_ti 14 7-G <br /> Physical Address: Z7oc);_ 81yd <br /> Mailing Address: _ • --- MQvnc- . .,.•. , ...•_,_. . . ._.. <br /> E. DESCRIP'T'ION <br /> Type of Discharge: Un auto by,m �' r . ovc� eG� a'r z cm <br /> Volume: <br /> Chemicals- <br /> Circumstances: <br /> A � <br /> F. ACTION TARN_ <br /> T'i r <br /> SITE DISPOSI'i ION <br /> EH 22 013 (Rev.4/9I) <br />