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SAN JOAQUIN COUNTY copy <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: II III PHS-EH LOG # <br /> (Circle One) 0 <br /> B. SOURCE OF INFORMATION <br /> Original Source: e lal7e `ebYe, Telephone: (600)odon0ox5il, 6 .n A UNoZ <br /> RenAgency <br /> Agency Contact: (�Qrn l�lo -� Telephone: ( Zoq) ub g'3�1b <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: Za5 eerkr l s fad <br /> (Best Physical Description) ( i 'or County) <br /> Date of Discharge: /�� 3 4q I <br /> Date Notified: to/3.q / Time: Z % y 3 �rYi <br /> D. RESPONSIBLE PERSONBUSINESS <br /> Name of Business P R C C <br /> Contact Person: TD h n T f4l)e-K Telephone: �//II <br /> Physical Address: 5 / S S • 06LICK 52L � 1 rg tXc!S 200 :7 <br /> E. DESCRIPTION <br /> Type Release: I - d r 1 vL o 4o- , <br /> Volume: I J 4 ed l m -s <br /> Chemi Is: 5 <br /> F. ACTIONTVAKE rffbr lot pCtr�� Campy <br /> A b50r ben+ We u cLo-p d -b C nc4at-v\ <br /> 0 C,7.4 5 t n4(e b(t�4 e Cj,1A1v1 U D 15 0e�1,0&ty <br /> EH 22 013(Rev. 02/90) <br />