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SAN JOAQULN COUNTY <br /> NOTIFICATION OF HL,Z.-kRDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 1 <br /> *, s <br /> A. EMERGENCY LEVEUD II III PHS-EH LOG T <br /> (Circle one) <br /> B. SOURCE OF INFORMATION <br /> Name: j C" +ir' <br /> Phone: ( ) <br /> Company: V E r a n vYN <br /> Address: T.e e-7k Au i 5 <br /> Designated Employee Name: Phone: <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATEwe-5+ <br /> ,, ``OP DISCHARGE <br /> Location: 3L 2- W e 5+ C1Lz6 -- <br /> (Best Physical Description) (City or ounty Circle one <br /> Date of Discharge: 'kd\. <br /> Date Notified: B Time. (D d <br /> D. RESPONSIBLE PERSONBCSINESS <br /> Name of Business: M S E Q-' '` <br /> Contact Person: 0,+f--1 Phone: - ?07 . <br /> Physical address: 3 aD S2 III �. �a c- <br /> Mailing _address: 0c C S1t✓ I <br /> E. DESCRIPTION <br /> Type or Discharge.- L�� <br /> Volume: Ct Lti <br /> Chemicals: e ( t r'v <'- <br /> C ircumstances: {' ti a a rCI.nj S <br /> F.- ACTION TAKEN c ct n r` S <br /> SITE DISPOSITION <br /> Q n <br /> EH 22 013 (Rev. 03/20/98) <br />