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*SAN JOAQUIN COUNTY f <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY <br /> LEVELO II III PHS-EH LOG # L)1 <br /> (Circle One) <br /> B. SOURCE OF INFORMATION C_ ICES Phone: 1c21 2 <br /> Name: G—c,, L�SA ENVNIMM <br /> OIiMAEN'►ALI�AL.TMOIVIiION <br /> Company: <br /> Address: ' <br /> Designated Employee Name: Phone: Uc�) <br /> Reporting Agency Name: S ct r "7'moo. <br /> Address: ygS ,.,.7, <br /> C. LOCATION AND DATE OF DISCHARGE / <br /> Location: ��� �,�/ g,-,-? a, <br /> (Best Physical Description) City or County) Circle One <br /> Date of Discharge: H / J <br /> Date Notified: /� Time: /vn <br /> D. RESPONSIBLE PERSON/BUSINESS /� �� s���� <br /> Name of Business: �'c.n.e Sc <br /> Contact Person: vh H ��« <e�'� Telephone: s <br /> Physical Address: / �y r �"?G�� SGS /cM <br /> Mailing Address: ;, 3 ,., <br /> ps zo 5 <br /> E. DESCRIPTION <br /> Type of Discharge: 6le� a u 1 011 ze <br /> Volume: <br /> Chemicals: <br /> �' G,.�lis1e o�� .� <br /> Circumstances- s ;//� lee. > <br /> e <br /> F. ACTION TAKEN �'�'� •'-� "`C4 Ov <br /> rJ 6 �P H2 `� 4 C�1111,,5 <br /> ivK <br /> SITE DISPOStTtON =04C 'lZe •-toC t-5 <br /> .4 . <br /> /� v` 5�v L&,/6- /%L1 uk c. r c� LJ c <br /> EH 22 013 (Rev.4/91) <br />