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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: 10 III PHS-EH LOG #_ 7. — JLJ;7 <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Phone: <br /> Company: <br /> Address: <br /> Designated Employee Name: Phone: y <br /> Reporting Agency Name: Cin C3 3 i <br /> Address: Ll y 5 ��,� ©4 �,�,� S t_ �vc <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 1 4ACC u/a,ra( /e' <br /> (Best <br /> (Best Physical Description) (City or County) Circle One <br /> Date of Discharge: 7- /6 -9 Z <br /> Date Notified: -z-16 - s Z Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: /,-/ <br /> Contact Person: f- -o-, Telephone: <br /> Physical Address: y'� C;.? P ' <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: / " <br /> Volume: � /� � ' <br /> Chemicals: , q J�rL <br /> Circumstances: �v„cr �P�, <br /> �L,1 l 4ry c!c <br /> iii •-ham G' �/irc/ nr�l 4,1 St O �f Ct/c4 <br /> F. ACTION TAKEN_11/,' 4/c -J' <br /> 2- 9717 41,9& �✓ar <br /> � <br /> ✓�' ,� off 4 <br /> coa ,.v ireo�'• r �? n7P9viii rf fc .- g�d P <br /> SITE DISPOSITION <br /> On <br /> �iec/74 <br /> EH 22 013 (Rev.4/91) <br />