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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE j <br /> HEALTH & SAFETY CODE 25180.7 t �{ PCD <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG #_. �"C � <br /> (Circle One) z <br /> B. SOURCE OF INFORMATION <br /> Name:_ ,k4e.tr� ` cc %�r fi Phone: U / ; 0 <br /> Company: Al u, <br /> Address: + <br /> Designated Employee Name: L,4--, ili`r, Lr i 44 S Phone: <br /> Reporting Agency Name: y+ <br /> Address: <br /> C. LOCATION AND DATE OF DISC WE <br /> Location• - T C ' <br /> •(Best Physical Descri tion) �r Co ty)'Circle One <br /> Date of Discharge: <br /> Date Notified: —/..3 — 9:S: Time:- <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: C- e S. <br /> Contact Penson: S Telephone: f D g - or, <br /> Physical Address: t-)? C' I <br /> Mailing Address: 4 r W <br /> E. DESCRIPTION ' <br /> Type of Discharge: <br /> Volume: <br /> Chemicals: "�► i <br /> Circumstances: 0 <br /> 0"_- Gvr?l firly,_E' 7 7'S <br /> F. ACTION TAKEN <br /> A- r 5 i <br /> a <br /> SITE DISPOSITION c C r & A7, 9' <br /> x <br /> EH 22 013 (Rev.4/91) <br />