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SAN JOAQ(`Lti COUNTY <br /> NO=C-kTION of ELaz.-kRDOUS WASTE DIScEuRFRE COPY <br /> RE.ALTH & SAnTY CODE Z5130-7 <br /> A. EN(ERGEVCY LL II ET FHc_�-� LOG T -9 • 1 <br /> Ti:firc;,t one) — - <br /> s. SOURCE OF NFORNLAIION <br /> Name:_ Le-4±i- ft SO; <br /> Comnanv- <br /> Address: <br /> Des tpaced E.mplove-- Name: <br /> Reporting .-k-gency Maine: <br /> Address: . <br /> C. LOCAMN ND DATE OF DISCI-LARGE <br /> Locanon: l 3 :S . va- Seo <br /> {Bzs Fh�sic:i Description] (C: ar County ) Circe one <br /> Date oz Disci=rge: ro-.e/y��' -- <br /> Date 4oriEcd: Tcrnc: l l 30�x•r . <br /> D. RESPONSIBLE PERSONBC;S^aESS <br /> Name of 3 usimess: <br /> Contac-. P!!son:_ _-* h,4v +'`j Phone: 7 Si-- �r7 Lz <br /> C=I <br /> Address-. ' <br /> . �•1�'S i �- <br /> Mallln$ Address: <br /> E. DESCRP.ON <br /> T,--pe of lD I s c fiamxe I ►'� <br /> V oiume- <br /> che"nicwis: m r L3 t e r ' <br /> D <br /> Circ:srnsmuc2s. P' <br /> F. ACTION T�� <br /> G, <br /> 5ITE DIST OSMON <br /> -=H 220i_ x.. 03,2-0/931 <br />