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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOU WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180..7 <br /> A. EMERGENCY LEVEL6) <br /> II III PHS-EH LOG #_ C��[v <br /> (Circle One) <br /> B. SOURCE OF INFORMATON <br /> Name: N!!t Lov f D" Ok5 Phone: � X23 cr <br /> Company; .)te <br /> Address: <br /> Designated Employee Name: Phone: (___) <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHGE <br /> Location:_ E \4ose-r-u / <br /> .(Best Physical Description) 'ty r County) Circle One <br /> Date of Discharge: Lw` .Sr�rl <br /> Date Notified: 4- 13-13 Time: Q=ad c w— <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: C) Quv-k-e—e- <br /> Contact Person:' KA.V4 L.ou P0n+<-5 Telephone: (7 2 l <br /> Physical Address: * c6exIN k 0, CJQ- R5331� <br /> Mailing Address: 0441 '5o+(L C4 g6s-z-� <br /> E. DESCRIPTION <br /> Type of Discharge; <br /> Volume: , GVXKYXOW12 <br /> Chemicals: - 5CL15 U� <br /> Circumstances: e- ►,J ' re, L s o a +ti• �G <br /> U-uC' <br /> F. ACTION TAKENt� re tree <br /> SITE DIS OSI ION s1 c)cp C.o.qi 5I (,( a <br /> -iv oelf avo-1 I& v <br /> O V lD cLat <br /> l <br /> EH 22 013 (Rev.4/91) <br />