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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> u µ <br /> A. EMERGENCY LEVEL: UX III PHS-EH LOG # ' a27 <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Phone: �) <br /> Company: <br /> Address: <br /> Designated Employee Name: Phone: (_) <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: Ao 1--9' txoj ynG1 (onoe, / Stpc-f'°✓l <br /> (Best Physical Description) i or County) Circle One <br /> Date of Discharge: Qy\k4 O\® J n <br /> r <br /> Date Notified: a•2-1•'q-' Time:— <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: Soo1Y1.1ancl <br /> Contact Person: Bob nt tNlani:) Telephone: (Zoe) 251- Yt 5 <br /> Physical Address: III d %)-05f Vat l2!�j t+1c1h Wal .D- I VeAt WFC- 4'903 Z <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: PE#ra l2 O M Laid roce-r b any <br /> Volume: Vn\An0 vn <br /> Chemicals: Eaa60t tv,v- Lovtsh hie'nt5 <br /> Circumstances: C1IDW\I Soil 0-nJ qy%Wv &L'- 4't1 Car 1drntM11&rg l n <br /> .5,,vvw ole 5 c otLackej &0jA U-A a �rQ- -f4 nk ttn uru, 0$5c8� <br /> F. ACTION TAKEN JKC t?AtWtV 0*-L29' &caLkGSe. wttl bk Gbn(=ry e <br /> Wt+'/\ Wuooec,,iyv2y , amacS15 f -fly 54roP(a.5 at)tLwAcd - <br /> SITESTATUS -rat Wit Lnf0 cc.( OL4 <br /> r r Cw�dyi,^ ad4z ty� l h t/es <br /> v' reM&WL04 h V to t7-,e ttK <br /> de 'T• v n <br /> EH 22 013 (Rev.4/91) <br />