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SAN JOAQUIN COUNTY <br /> F HAZARDOUS WASTE DISCHARGE <br /> NOTIFICATION O � O <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVELOI II III PHS-EH LOG # <br /> Y7, <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: 11iles L Z S Telephone: ( ) <br /> Reporting Agency Name: �A �� �- I c,rr-I S!-1-✓iCSS 0` -. W ToA-6L0/N <br /> J� { p (20`/) 4'6&-3k� 0 �HNty <br /> Agency Contact: O nJ N� t�.-/� i� Telephone: / <br /> Address: 9. 0, 1901 2001 6-14 <br /> C. LOCATION AND DATE OF DISCHARGE ��A <br /> Location: 26500 6H91SMA-M 14/ TQ�� V� 6f eir3-76 <br /> (Best Physical Description) (City or f6ounty) <br /> Date of Discharge: -W♦fib w v% <br /> Date Notified: - I 6—U 1 Time: %Oo I+—n'1 <br /> D. RESPONSIBLE PERSONBUSINESS <br /> Name of Business -_ 4::tA 0 n-i-3&r :EgAcN GG <br /> Contact Person: Telephone: (Z(J`%) 03 Z- 5� 6 <br /> Physical Address: Z 710 6tIg-& �/ G <br /> E. DESCRIPTION <br /> Type Release: ��J A 114, o <br /> Volume: Uri know <br /> Chemicals L/ a I e vt vti 1 � o( V v A���n45 <br /> F. ACTION TAKEN <br /> ro n d ar��s ( Svn� re-y, ,o ✓�( a nl <br /> /0"SF-49 /D <br /> FGt Ali F/L S /KS�SSin e,-f- W iL L /,e ✓ems, i/2 ems( <br /> Ir, i h ei 4-te- N a A-y ne, zx-A i <br /> /D&)-r k M 0 A'r l 01J Q s Y PG w i t b t1 d �✓1 I1��" <br /> EH 22 03 (Rev. 7/89) <br />