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i SAN JOAQUIN COUNTY <br /> t NOTIFICATION OF HAZARDOUS WASTE!DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> i� <br /> A. EMERGENCY LEVEL:CT ti III PHSI EH LOG <br /> (Circle One) <br /> 3. SOURCE OF INFORMATION <br /> Name: 5' F,� B ��d N Phone: aY6 <br /> Company: $-0. <br /> Address; O ZZ wmeR. F. c-I. <br /> Designated Employee Name: I[ Phone: <br /> Reporting Agency Name: <br /> Address: 15.jcrV. <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location• Co4G�r'�klu� S? ��-�� �e�{,��s��/ cx��1_ ._..— <br /> .(Best Physical Des ' rion) �or Counry) Circle One <br /> p <br /> f Date of Discharge: d7 /7 4z <br /> f <br /> Date Notified: Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: Tari! <br /> Contact Person: /i AJO Telephone: 77t <br /> Physical Address: /7 ZZ -1ho d <br /> Mailing Address: 2 2- -*s n1vQ&A--9 �oEsTv - 53s- <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> I volume: - <br /> Chemicals: NYLpuG FGv�'✓� p <br /> Circumstances: ,4��.a�n� ST�l.� �1 �2 'GfilSE orc fo�_�� h <br /> 7b �E AtiW4 � � k <br /> F. ACTION TAKEN -5. S- _Gy 73y - rF �i?fit. <br /> SITE DISPOSITION 1 wA± <br /> It �M <br /> EH 22 013 (Rev.4/91) <br />