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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: 3 II III PHS-EH LOG # ��✓ <br /> (Circle One) <br /> B. SOURCE OF INFORMATION _ <br /> Original Source: �L cG�S Li IC Telephone: a( oy )L1&6—�J5000 <br /> Reporting Agency Name: . �aAl a C,,,, pffS — �• /�, �r'I/ <br /> Agency Contact: L) a a) Telephone: a( Oji ) V&P -,3 V d-O <br /> Address: R 0. ( 1—, (4?0 0�q, S� c K C14 95a o / <br /> C. LOCATION AND DATE OF DISCHARGE StD C `{ � <br /> Location: /1 f D rj F , l t 7t[ feh Q4 Q / <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: 4Lbji ez[M� <br /> Date Notified: 16-d L/ - 90 Time: / • <br /> D. RESPONSIBLE PERSON/BUSINESS _ <br /> Name of Business -- CI av 7;�PL-)d5 Jig C <br /> Contact Person: Fra4i K N9-ilp, Telephone: <br /> Physical Address: <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: -GL,nk� <br /> Chemicals: /,L)0 Sf' <br /> F. ACTION TAKEN <br /> k b m a sem ttP&u�� <br /> r <br /> i <br /> EH 22 013 (Rev. 02/90) <br />