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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVE Ia I>II III PHS-EH LOG # R O 6 <br /> (Circle One) \� <br /> B. SOURCE OF INFORMATION <br /> Original Source: ('�:��kr ��tAr r� Telephone: <br /> Reporting Agency Name: 's'-wk °s <br /> Agency Contact: CjVIrIF5 Telephone: <br /> Address: Sam rin-n•rr S¢ 2Crk+,1 j 95.2-0Z <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: _ S AweriCr4" <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: 1.11Jt"rxA7r.1 <br /> Date Notified: 9(/2/(jp Time: <br /> D. RESPONSIBLE PERSONBUSINESS <br /> Name of Business S ' lir ir� ( �,rn,rrr� Ivy <br /> Contact Person: jinnd Telephone: 2,15,- <br /> Physical Address: CaO S <br /> E. DESCRIPTION <br /> Type Release: PSA <br /> Volume: t.t ti lLr,3 Qw L-j <br /> Chemicals: kLL—�tAm, `L�rlrnmr- `NS <br /> F. ACTION TAKEN <br /> G> f <br /> 7— <br /> I Ar'f�Pi- /.yl�j 'hP 1-fr�urrA-.� -1"n Cl'PfPf'YVI/Ne - _ <br /> _NrtiFt�n� stir/ PPn� i7nrFaw r(�7nN 67S rR�wM D tri <br /> C� <br /> EH 22 03 (Rev. 7/89) <br />