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�.. %Ed <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180 .7 <br /> A. EMERGENCY LEVEL: II III HEALTH DISTRICT LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION i <br /> Original Source: (2-1wf(P5 tf,-� Telephone: (^ ra) yj�F—gy;z[5 ``/� <br /> Reporting Agency Name: iv JOrX/LV (!X/�tlY�s LlXcrO /7Pp�f� �j�{lKT <br /> Agency Contact: �/J t_ QUA) Telephone: (-2ja) <br /> Address: lei Po. anzacra S(KNCA Pa 201 <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: g� S. 4mPryrAN / _�_ockbN <br /> ( Best. Physi:: :-.) Poo cj j:C � .:: i ( -"iLy ui County) <br /> Date of Discharge: 0okf-incA.r.1 <br /> Date Notified: 5/e2.2dyq Time: 4/0 pry <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business Snbolyd C,==n-}iON <br /> Contact Person: aelC[�j Telephone: (2(7-7) <br /> Physical Address : _'320 S AiY1P1^ICp/ l <br /> E. DESCRIPTION <br /> Type Release: CAAfc rLec <br /> Volume: ('A�,KN�wN <br /> Chemicals: 1, <br /> F. ACTION TAKEN �� I_ <br /> —Tr"k rewlvaf � , rrrS A1+S rPL)QCAIII r1 ( C1 r�kj40Mf),j(h�In►J, <br /> I r.4f+(nor ; tti r�' P ynw��7< r il/ b� P orliiit -Ay <br /> �P 1�1�FGire Qhrl ek�Pn�f r7F 5 reo lf-P <br /> �j bhp c�PPr'^�rir,�fie �u/c:fc� ��rNcy <br />