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SAN JOAQUIN COUNTY ✓� <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE h <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVE II III PHS-EH LOG # y <br /> (Circle One) <br /> B. SOURCE OF INFOR/MA/TION <br /> Original Source: y 1/7 <br /> OS tk Telephone: ao <br /> Reporting Agency Name: n pp � '�O � <br /> Agency Contact: 'r R�Se Gk Telephone: tv v r z16 Sri <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: YJ 39 Nai,,24A 92 C, <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: --- - <br /> Date Notified: ,/—/ Time: ,60Q2212 <br /> D. RESPONSIBLE PERSONBUSINESS <br /> Name of Business _ 72n✓�Zd1- • �S �� '� ='� <br /> Contact Person: 'C/L L Telephone: QLD 921,"51'6 <br /> Physical Address: 3 QlOrr/4h,,U C14 (F,6.?6 S <br /> E. DESCRIPTIv Qa"&a&ryo D. (E 5-57Sj SfoGKN �ao5 <br /> Type Release: i//�a ��'�rlrK 6✓ 1ClSf Di�GLvrC� �Lu'�L S'7o2 � E�iILJr� <br /> ,W&SXeSo� fa y <br /> Volume: ire kT-0 ' <br /> Chemicals: <br /> F. A�A dt�22°� riY1 ves Fi 9ct{tBrc. re�Ka�c I I cEgosccQ. <br /> �� •/ CXitL C�,4�LCs 7!o <br /> U <br /> EH 22 013(Rev. 02/90) <br />