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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I I III PHS-EH LOG 4 01 -OO S <br /> I ircle one) <br /> B. SOURCE OF INFOPNIATION <br /> Namel�OGLVL" Phone: (�Dq Wog- 03x1 <br /> Company:S3-C- P4S-Eyw lrOnyyy ZX tfLk blNlSl n <br /> Address: SDLA E vJ2,b2,r Aijey1,kk ,TvuAd F1,txsr—HCl-Tan CA ci5=2- <br /> Designated Employee Name: A ,y- '1 Llntn�ololLl'�d Phone: ZCC(-y le�S-9SAZ <br /> Reporting Agency Name: 4-)btS-04 T*) <br /> Address: V,)e)<DCk-- AQC JhA:6d F't.oOr} S-b6J&'onCA 95Z)? <br /> C. LOCATION .SND DATE OF DISCHARGE <br /> Location: (O /e CLCQ (Z0o-J / <br /> (Best Phvsical Description) (City o unty) Circle one <br /> Date of Discharge: l.l.V�61A-T-Y1_ (e6V1L <br /> Date Notified:1 .yI? \ J Time: 1',30PM <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: LfDV,�ac-2 Sto-tL-on <br /> Contact Person: BG-LZv" Phone: q$Z- <br /> Phvsical Address: 0,33,3 LpUeA CLC QQ ?,U0.Ck, MLAt C 0. :9 CA 25 a3`1a* <br /> Mailing Address: P O &X)K 1 R 1 D Y51"Odc-A-o✓i C A ci SZO 1 <br /> E. DESCRIPTION <br /> Tv <br /> pe of Discharge: 11 Ql l,I'�IDY l P YP Ien-s" �vC)w1 '1YtALL.V06LSISc ti C�Zlrt <br /> Volume: LW fV Y10o.�A.. <br /> Chemicals: Y 2 CGL <br /> Circumstances: 1'10 'l l' GIC.VVC)LS CLS <br /> ,IU� tin- 42jr"-r- <br /> F. ACTION TAKEN <br /> SITE DISPOSITION �Y1bW V1 . Y vv V <br /> -�u Ck;C1VC,�11M w Q Gl <br /> EH 22 013 (Rev. 08/20/08) <br />