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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVE I,I I� II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: _C I'ar!a_. 57 YAht`�' Telephone: <br /> Reporting Agency Name: I+N o22x2,v la pIkk r, <br /> Agency Contact: Telephone: 22 -'/63 —311Mo <br /> Address: P.0 3W 20rna GA- <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 221 N. GordiNlyxj / _ e-4e�,ck�nN <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: (1,A rojow j <br /> Date Notified: 1 1 f s bo Time: Z;3a yrs <br /> D. RESPONSIBLE PERSONBUSINESS <br /> Name of Business <br /> Contact Person: M,ke C'ntrj m— Telephone: 9qfs--21100 <br /> Physical Address: Z?1 N. (,Orr)„Wux( C-,-fOCA} C4 <br /> E. DESCRIPTION <br /> Type Release: (A uLtct+�a^f?E�� <br /> Volume: ( Ux'6u.ti <br /> Chemicals: porn f FUAm <br /> F. ACTION TAKEN <br /> 75..k rv?�mnala�s T 41�carotc� / �n �nzmrNrrf rn csf fie S/i/icun// <br /> � nPc 5;-6 GS^(�< Gvro�1/ /� // r�,�ir43 fn r1 <br /> 1 <br /> '11)T1^M1r!p,// f"�:,r�nt'c� �1 nAlrlPr <br /> Ell 22 03 (Rev. 7/89) <br />