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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180 .7 <br /> A. EMERGENCY LEVEL: I II III HEALTH DISTRICT LOG # –Aa (— <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> 1. <br /> Original Source: ANOw-6 ;F0j/1P-(w elephone: <br /> Reporting Agency Name: CA61 ,70-4 141�' L.V644-(, &iVV-) b1,S-r2/L> <br /> Agency Contact: Lt/ILL/7)n R S,✓A✓B/�elephone: (,70j) b �3� .f <br /> Address: //j/ D/ � 7F� L. 70N S77CI✓, <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: �(/Q� Si /IZiAOR� INGLN / S7a�Kyor✓ <br /> (Best Physical D scriptio (City or County) <br /> Date of Discharge: (/i1/kmb"/^/ <br /> Date Notified: 3 13QZff Time: 3 3o PM. <br /> D. RESPONSIBLE PERSON/BUSINESS /� <br /> i Name of Business -5TdGyt7a 1J ML?Rd 2d LI n9N Al�Pb� <br /> Contact Person: -D/}N be A t4GELiS Telephone: <br /> Physical Address : 5-2) © 0 5, ,6ieR er agaq C TG1k 1520 <br /> �J <br /> ' E. DESCRIPTION <br /> Type Release: UNGcIn�Liy�/�� e�f� <br /> Volume: VAlk&10W Al <br /> Chemicals : G]QSOL iNC f'YrP <br /> F. ACTION TAKEN <br /> K7/+ 2 Si{e 1t55e55MenlT (,,) iLL b� 1'tlau/ 2evf fa <br /> 0(8 fzK rn lige fleeA IdA4 re £ 0 r� L1e,,J7f1'M fNF-7'/o Al <br /> AS Lz4oj"-al h v 4-tit, G pnronriAh V-e t4d-a! aj / <br /> copy <br />