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Ir SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE �� """ .� <br /> HEALTH & SAFETY CODE 25180.7 , <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG # �3' D33 <br /> ( cle One) <br /> B. SOURCE OF INFORMATION <br /> Name: �t6 6,vk,&U,0Phone: (2,eg ?- <br /> Company: L� G <br /> Address: 16 Uv L 14 2d Gam, � <br /> Designated Employee Name: _ P one: 1709r. - ZG' <br /> Reporting Agency Name: <br /> Address::, o, 6 D-XI <br /> e <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 9'!.� Li�y�-tJ Gy 7 <br /> (Best Physical Descnp, 'on) (City or County) Circle One <br /> Date of Discharge: <br /> Date Notified: Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: ' r"" FL �-- Co <br /> Contact Person: m LA e4.tib Telephone: Igo V - f <br /> Physical Address: !��a la-�V LAJ -- 5i k--70:';z <br /> Mailing Address: ssg-Mei <br /> E. DESCRIPTION <br /> Type of Discharge: i I r <br /> Volume: o v <br /> Chemicals: $A <br /> Circumstances: Mcg <br /> F. ACTION TAKEN Le—, 3 E(.. �•b S o .� � <br /> +r <br /> 2ci P� <br /> lit o` Ism o-S <br /> SITE DISPOSITION No <br /> EH 22 013 (Rev.4/91) <br />