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SAN JOAQUIN COUNTY'S <br />NOTIFICATION OF HAZARDOUS WASTE DISCHARGE Q <br />HEALTH & SAFETY CODE 25180.7 .6 <br />A. EMERGENCY LEVEL II III PHS -EH LOG # <br />(Circle One) <br />B. SOURCE OF INFORMATION <br />Original Source: _ C'4arlp� .1 1- Telephone: (2 ) 7 5 d <br />Reporting Agency Name:'- rte+ Chin. 6 SPrtxcPs <br />Agency Contact: .[acle.-- &±„ ^_ Telephone: (Zcg } <br />Address: Q Dl <br />C. LOCATION AND DATE OF DISCHARGE <br />Location: __21675—Au <br />(Best Physical De cription) (City or County) <br />Date of Discharge: ,v�uN <br />Date Notified: 71 Time: <br />D. RESPONSIBLE PERSON/BUSINESS <br />Name of Business 1<13 S <br />Contact Person: --I r RUQ 1 Telephone; 2m j7" --2'1e0 <br />Physical Address: -7-367 S ' <br />E. DESCRIPTION I OF <br />Type Release: t <br />Volume: <br />Chemicals:s� .� <br />F. ACTION TAKEN <br />a Sow P co ate, <br />EI -I 22 03 (Rev. 7/89) lk% <br />