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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH 6 SAFETY CODE 25160 . 7 <br /> A. EMERGENCY LEVEL: II III HEALTH DISTRICT LOG <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source:k"-44 �e0/- Telephone: 7,2-0 <br /> Reporting Agency Name: Sq�//T � =// <br /> Agency Contact: LftN�'iE (moi/N//,g Telephone: ( ( W,?SV,20 <br /> Address : 12, D SOX �Lo017 e)1v `(-� 97 <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location; C/�� S• ! P� L/ O / �7��i L , / <br /> (Best Physical Description) (Cit or County) <br /> Z1f-DDate of Discharge: 171-21f- <br /> Date <br /> ate Notified: j Time: 11'4),9 <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business <br /> Contact Person: Telephone: (_) <br /> Physical Address : 9/ol S, 6,,Z1✓7:512 <br /> E. DESCRIPTION �/ / <br /> Type Release: (/ji/fjy�(�cp2iZzr/ Gr/SGLce 7/P S��✓e 2 <br /> Volume : Ui✓�`Ji�G✓i✓ <br /> Chemicals : <br /> F. ACTION TAKEN <br /> _ �2/Hem si;�� crssrss� f u„GG (oma �r��za/ /z, <br /> yafhrce- a -P-r/e,f- o G f�.✓��.tri.✓�7" <br /> Ce 5, by /W< ! i/o ,ea,P2iu <br /> e de 4,7 <br /> La 6 �.v�-Lyses <br /> {2�Geiv� D i✓ S/a_ �y` <br />