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• SAN JOAQUIN COUNTY <br /> NOTIF,u�, OF HAZARDOUS WASTE'DISC*,-m-AGE <br /> HEALTH & SAFETYCODE-25,180.17 <br /> LA <br /> irii. <br /> A. EMERGENCY LEVELQ 11 111 PH EH LOG <br /> cle One) <br /> B. SOURCE OF INFORMATION is <br /> Phone: <br /> le . y51 -1r- <br /> Name:Company: F1Y,-v,(0W? <br /> Address:. E) az)i <br /> Designated Employee Name: 11. Pho6e: C--) <br /> Reporting Agency Name: ii i <br /> Address: ii <br /> C. LOCATION AND DATE OF DISCHARGE APN <br /> Location: 1442Cf8' or,L I e,1/00 lc(-ml <br /> (Best Physical Description) (City ojj!!: oun ) Circle One <br /> Date of Discharge: UVAW� <br /> Date Notified: 3 Time% L30 L>m <br /> D. RESPONSIBLE PERSOBUSINES ji 1I. <br /> Name of Business: <br /> Contact Person: Ntccr 10 L J .1i Telep hone: <br /> Physical Address: <br /> Mailing Address: -P 0 lt;a 2 1 1l <br /> E. DESCRIPTION <br /> Type of Discharge: tAA Ck,,-i r) <br /> Volume: 1Z <br /> Chemicals: Ij dCh(C>r'b4ejhqfe,-P--,L �Z3QPQL LL <br /> Circumstances: I ?-JLm 1,bialu- 11 ii <br /> bnLt�ttC j� Wall WCT- <br /> CiUr(n5 0 "h" CLW&, !&6W01) <br /> F. ACTION TAKEN <br /> ve4cvyx 0�:2702L <br /> SITE DISPOSITION <br /> -je n cn f, <br /> ii <br /> EH 22 013 (Rev.4/91) <br />