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SAN JOAQUIN COUNTY - <br /> NOTIFICA�ItON OF HAZARDOUS WASTE DISC?6,RGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL I II III C PIYPHS-EH LOG # _ <br /> ( ucle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Lab mgc,r-4' on Soil se mP�Q Phone: fat `i5a•0353 <br /> Company: 0- a vlon le- f W esfi2-► <br /> Address: F-3 v.A5 t' IAVcVti t-O-r-s, arck+D1% C",4- <br /> Designated Employee Name: Phone: (� <br /> Reporting Agency Name: <br /> Address <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: EZ71- 0-Vanne) <br /> (Best Physical Description) City r County) Circle One <br /> Date of Discharge: U4141svt 0 _ <br /> Date Notified: •(v•Q2 Time: Z' 3U P <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: Ayli-u' to t ebrutha� -- �'L• �'°�` t� L1 5tk,n CA g5z�i <br /> Contact Person: lk4rtz�lr-15 Telephone: (� <br /> i Physical Address: 1=•50 506-t LI hann-d 1:6f. A-F K t` 153- os0- 03- ' <br /> Mailing Address: tz2 N Wtls01% Waw( St-cctctcn CA 4SaQ5 <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: 0r1KmvJy) <br /> Chemicals: o�,,,tar past: t ri C, <br /> Circumstances: , 4.e. ,�•Faty5 eya.lua.fwe-L <br /> F. ACTION TAKEN und.oA royr A t C 'fiWu�1�5 Vvto✓� L� -23 t4�� <br /> go-5L U4 CCn.�d4LaAtwvr Q5etLt . ve CLwxr�vw\ ties wttldcruvuAkd <br /> trJt J VN � U Q K rQ ar-f. -f I-e s a1 i-wLc 0(d fit% <br /> t14- <br /> ov-,l-amtK&, 5 tl.e_ CLAt bqs'e . Fvp-9)-e-t t ktu8 h c r.o•, rt- t- LCL <br /> SITE DISPOSITION A &Y- L-6P-- t,141 h.2 - rwJA— <br /> jnUet-a j� p—oak-N otgfL t. rjpft{i jLL4 r✓ewfle-S 6t- neSl cl <br /> �1.Vlt�llmcrttt �• • <br /> EH 22 013 (Rev.4/91) <br />