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SAN JOAQUIN COUNTY n <br /> NOTIF i.,ATION OF HAZARDOUSP WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL I II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATON <br /> Name: (ad Dv�dGs Phone: zoo° }i '�23R157 <br /> Company: . n(2 J&v - 1.4 rrf <br /> Address• <br /> Designated Employee Name: Phone: („`} <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: E 4c>Se–m( -K— <br /> (Best Physical Desccriptio) 'ty r County) Circle One <br /> Date of Discharge: <br /> Date Notified: '4- 13-13 Time:--- Dd <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: PcwMe5 au+-fie- Vfe' cot� Wash <br /> Contact Person: t.0o 1pch-t�cS Telephone: Z -171 <br /> Physical Address: oservIc k- 04 8533 W <br /> Mailing Address: t N4( Sw+(LCfq 4532 <br /> E. DESCRIPTION <br /> Type of Discharge: ,�vwt droe—tz - 4;i ua Pre-c- steviTesf- 1 eak <br /> Volume: t) w <br /> Chemicals: Maj. - 5CV5 4 40 uAcel-e- , 1( <br /> Circumstances: CL teLQ resvt+s o CZ m,*-- <br /> f-:21v,r6L UCj1qn <br /> ]]. <br /> F. ACTION TAKEN JPi LM r2 tr4nj Lk\ <br /> SITE DIS OSI ION Si LxS Lo✓t+aA717 <br /> v C ave e � Wi6 <br /> l rtu�,s� uft o-� a re L1 f v' u k-Ad t0 <br /> f <br /> EH 22 013 (Rev.4/91) i <br />