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SAN JOAQUIN COUNTY r <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL I> II III PHS-EH LOG # 90 - a /s <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: clmrfe< H,,,.,-f- Telephone: (2129 ) VEK-311YO <br /> Reporting Agency <br /> /1fName: Buhl,c Hf •,44l Sard1(e5 HP"AgA <br /> Agency Contact: NuNJ' Telephone: (fit) ) ) 19--3./yo <br /> Address: PO- Eox oTOnq S'}orl;-l'nr r4 9<;�0/ <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 16Nq C r(^n NPI l 91ork-lb^j <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: <br /> Date Notified: /U//qp Time: // , 7QAM <br /> D. RESPONSIBLE PERSONBUSINESS <br /> Name of Business F iAn <br /> Contact Person: t7acycrr Telephone: (2& <br /> Physical Address: /6'/9 f PG ,Niel S-�,rk4r,.. (A <br /> E. DESCRIPTION <br /> Type Release: 1,14P <br /> Volume: U'Lefjn„ <br /> Chemicals: Pelcdrur, <br /> F. ACTION TAKEN <br /> i�N k Reffem / c / % aLly- <br /> Q�t"� P�y+,v� pT /'D.a..�//�Y7/NGS//CIN DS �r'Pi1r��•Pr� 'Dti f�YJ -P D/YLLT•C <br /> EH 22 03 (Rev. 7/89) <br />