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SITE STATUS <br />4β€”LA <br />β€”//k7,- 74- <br />SAN JOAQUIN COUNTY <br />NOTIFIC-ATION OF ,T-IAZOUS WASTE DCSCARGE <br />HEALTH & SAFETY CODE 25180.7 <br />A. EMERGENCY LEVEL: ,f) II III <br />(Circle One) py_EH LOG # <br />Aβ€ž- <br /> <br />3. SOURCE .OF UNFORMATION <br />Name: L' c_- <br />Company: <br />Address: <br /> <br />Phone: E2 <br /> <br />Designated Employee Name:/i 7 -7- ', ,r A-!.. Phone: ac?) '5'4 - 3 4; <br />Reporting Agency Name: <br />Address: <br />7.) <br />Location:, 1 <br />(Best Physical Desc:ription) <br />Dare of Discharge: <br />Date Notified: / - f Time: <br />D. RESPONSIBLE PERSON/3 'SINES'S <br />Name of Business: /,///β€˜ F-0--oc: <br />Contact Person: p Telehone: (.761) /-7.; <br />Physical Address: . , <br />Mailing Address: . cii,vyuL <br />LOCATION AND DATE OF DLSCI-LARGE <br /> <br />(City 0,`"Cr5unryCircle One <br /> <br />DESCRIPTION <br />Type of Discharge: <br />Volume: <br />Chemicals: / <br />)-11 0 , <br />, /0 sr"' V -7 4 Gl <br />AC-11QN TAKEN <br />1.11 <br />(), <br /> <br />Li, r-' <br />.e,dit--/ ctrril <br /> <br />Circumstances: <br />Ct <br />EH 22 013 (Rev.4/91)