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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180. 7 <br /> A. EMERGENCY LEVEL: lI II III <br /> (Circle One) HEALTH DISTRICT LOG # s�--O/ <br /> B. SOURCE OF INFORMATION <br /> Original Source: -62L) Telephone: <br /> Reporting Agency Name: �/}� lkj�F�IA�IJ LOCNz_ 4trr T-�+ SNlkcr <br /> Agency Contact: I . ( - t7 <br /> Telephone: <br /> Address : Cpl G. [6 j A-j STKI ) <br /> C. LOCATION AND DATE OF DISCHARGE <br /> a <br /> Location: <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: D(.T. 2211g8a <br /> Date Notified: Q cq-- 22 198 Time: _ <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business L(ekt-St)"Z-yo 4 <br /> Contact Person: CttgA , Ebwk -JS Telephone: <br /> FFOS) 210 --1004 <br /> Physical Address : �IJICl �nx1�� <br /> E. DESCRIPTION <br /> Type Release: keWY 1b0&A LLe-pS pF (, j�i �t SPILLg <br /> Volume: f}P_ yQtgX• lDo rYro TD U6S� <br /> Chemicals : �j`r2tT�5E"*) <br /> F. ACTION TAKEN <br /> �Qt -i-� (nkSOLAL)E IAIIFS }— F(Zf�tM Q� IA�LT?� S�P2QY1�� <br /> -1�2LtlV`5 L'1�(`{-sif'/I�t�� 70 `Ktrn i�:MC Y\s <br /> v Vrt <br /> - �� STl1�f� or ath�r` f)tDik ory a5ep.cy, )` wreck <br />