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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 O <br /> A. EMERGENCY LEVEL: I[ III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: Telephone: Z( J% ) c/lo8f-Syfl� <br /> Reporting Agency Name: h/ic lPi /f! SP4 lCPS <br /> Agency Contact: navn/ DL- Telephone: O /mak -3z/(o <br /> Address: 16o/ <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 3535 e, Chet-akee_ / n 77bcz <br /> (Best Physical Description) (City or County) <br /> Da?e of <br /> Date Notified: 8 .a 3 J-7 Time: //,og/"? ' <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business <br /> Contact Person: fru c P Dov/sPy Telephone: (c;�" ) <br /> Physical Address: _35.3( <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: - <br /> Chemicals: f P. cr <br /> F. ACTION TAKEN _ OB ✓c7� �/ii ff 1i t n It #� ><1-n2�a�leak &+ hr <br /> "'2Z/ ` pi ` ! 1 <br /> /2 <br /> pLe m s <br /> c <br /> EH 22 03 (Rev. 7/89) <br />