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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH 6 SAFETY CODE 25180 . 7 <br /> A. EMERGENCY LEVEL: I II III HEALTH DISTRICT LOG N� Q/ <br /> (Circle One) <br /> B. SOURCE OF INFORMATION p <br /> Original Source: —74+E �NH451S LABOI' ep�ne: <br /> Reporting Agency Name: LAAORA-7ote --:TNt- <br /> Agency Contact:( N �C G2G✓K Telephone: r! L/I -0 <br /> Address : 37 Z 7j myEe mENT �OULEVAKp yWA�/� �fyf,�� <br /> C. LOCATI AND DATE F DISCHARGE <br /> �oeo NEw ,�[.��Yn/o, <br /> Location: S� W1 <br /> (Best Physical Descrintio ) (City or'LC unty) <br /> �iV► dln h ec„(G� +&V-v unudxnc o-�t, oL /!h-ta� .ja�ht � oY� I l/Zo�87r <br /> Date of Discharge: (A h l<vt o W h <br /> Date Notified: 67 9 - Time: / ; 0ZJ <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business 57UG��Oi✓ �'D`ne� Qyefi(/ L-ClIA7 IO <br /> Contact Person: CGS 7 KyL Telephone: <br /> Physical Address : <br /> E. DESCRIPTION <br /> TYPe Release: K) C, Y1c-z! iZet) I"Z en5C% So C d LJQ/2i im y <br /> Volume : y\ v- 0 w r\ <br /> Chemicals : KLA} 1. � rh n G FINC 7i1/i6G cu' /tq?bc. / <br /> F. ACTION TAKEN PeMztti. c/ —jeC�� r ,,,, � �( y /� t.te5 <br /> G S S N 5 fS V v� �`} (/" i �L. .-/�� L Y`C% .) 14 I R t'<I � of 4'�'1 ✓�.l Prov <br /> -7 /nl 0a-7/0 .) <br /> COPY <br />