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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I 11 II PHS-EH LOG # <br /> (Circle ne) <br /> B. SOURCE OF INFORMATION p <br /> Name: ark (c.r .t cJ�v� Phone: <br /> Company: S <br /> Address: P n R. � S-7 L(S 1p�fv\o^4_ 0, ,5 4f 3 7 <br /> Designated Employee Name: lei no. 2 a -V\, �-_ Phone: to,, ��b r-0 33 y <br /> Reporting Agency Name: <br /> Address: (4 14 S ,t/ <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: ►Z z� S. e e <br /> (Best Physical Description) (City or County) Circle One <br /> Date of Discharge: <br /> Date Notified: 6,a 1- Time: S'r 30 �•M <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: Q, �<< S o <br /> Contact Person: VA-r Telephone: (S1c) <br /> Physical Address: <br /> Mailing Address: 5-1 C ..4 `,S H 3 7 <br /> E. DESCRIPTION <br /> Type of Discharge: T,M\ 15 0 4,nm i�,Devtstr� <br /> Volume: e/- 1 4 s1149.2 , <br /> Chemicals: s �Kc <br /> Circumstances: .,3 �o vs e Q x r�,`sra�sc i <br /> G'rtclp 42 ,J/Cd <br /> F. ACTION TAKEN -7-he <br /> SITE STATUS Ala A� <br /> EH 22 013 (Rev.4/91) <br />