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r r< <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:�P FP'H <br /> IIIII H LOG #—!q I qq <br /> (Circle One) <br /> B. SOURCE OF INFOWATION <br /> Name: Sm e Phone: His 8 7 y- 3 i 5 y <br /> Company: G✓" �r — / d c Cor/sv <br /> Address:Seo /atG� f rem Sy; �e IOC <br /> Designated Employee Name: Phone: �) <br /> Reporting Agency Name: _ <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: r3 S)(Dc) >'- //'-J'/ 3 / V/?'- <br /> (Best Physical Description) (City or County) Circle One <br /> Date of Discharge: '/-n/ 67OZ✓/' <br /> Date Notified: S -Z-2- �/ Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: <br /> Contact Person: -Ivar%ey (�,s�or _ Telephone: (aLs) 9 933 I <br /> Physical Address: 3 Soo S. Nwy 33 crn,1its <br /> <' <br /> Mailing Address: 3v7504 -5 .Cf,, -� iIc ( S , f Wi nuf C'fee , G. <br /> E. DESCRIPTION <br /> Type of Discharge: oti, '4 <br /> Volume: <br /> Chemicals: 6 i) 0 O.F. 112 - D,`c h o� g�c C�?., o s e , 70 ma c . <br /> - -- es: I ?c,.I ,+YyCSC-f'-• - /�r Ser�i'c� :+�lyrn r Lc4 <br /> Ne z!4eL - <br /> F. ACTION TAKEN J"I en v�tow yny'd Co vc of ,r <br /> 41�76). /fes' /cc/- <br /> s • Sol s /' <br /> ��r sbot� / /'2 a ra'/ +,�/�/C �rvza� r v4i �ous <br /> elefAi5 /Xl©c✓ tine Sy�t�cr <br /> SITE DISPOSITION � < 1/4- v i f�C- lee; ,,� n <br /> �f f I,c C� II-�rn�a 1�•e�h>.,a� l-•�4-�-n- �-u a���y �c�n-{ra � oar �C(�y c2c� � , <br /> r <br /> �vr f�ri r.•�c 5'55 PSS. <r��' %S i9c'r eSS�-�y � a�e rz�-,r�i n c <br /> /C e X 711.7 v rsli9 k1"91i7 4 1"I'04 <br /> El-1 22 013 (Rev.4/91) <br />