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SAN JOA,QUIN COUNTY e <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 D nED � <br /> Lr <br /> A. EMERGENCY LEVEL: tJ II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: Telephone: 1C'� <br /> Reporting Agency Name: <br /> -<4N 'SD,Q[�wtJ co r°�r34-tC N�c'-� sE�vr�6s <br /> Agency Contact: Telephone: <br /> Address: —,145; A/ _-,44 , o, t i s-r. <br /> C. LOCATION AND DATE OF DISCHARGE �oG e-4 c? Zo7 <br /> Location: 1,0 4161 LNIoe a- / <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: iN to C1,11 <br /> Date Notified: 2/6 I9 Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business VAI-LOL �'v4/NE <br /> Telephone: <br /> Contact Person: ��r..�n,LU,2-nit P (-� <br /> Physical Address: 12 " s7� <br /> E. DESCRIPTION <br /> Type Release: J'��� °PI'�� RFi �f U� �tvio�. i/GtG4>✓ k`�(� <br /> Volume: 1"N <br /> Chemicals: <br /> F. ACTION TAKEN <br /> _AX'112L /z IAF ��iGQ/ ,c�4G4G4Tr�.AL r1 R� '/T G '•e7 �" <br /> rt£ <br /> -r/1NK A° 4epviJL A :w fc/,`�!� vn( lAY z3 f�t�S/ cv�F/rati6 T�� ��E NCF <br /> vF �oK+nyutnl�fE� Fc> NF ' sr t r A`��F S�i�iFcc�//-L L?r <br /> �ly'�'Ite�D r0 a"�-,' r2�Uti,C 7'iiE lJ,�-r'�e-E /�N�� l=xi�T n� cvnK/l•,/J�7�7/b/�l <br /> /.(1 6 <br /> EH 22 013 (Rev. 02/90) <br />