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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: )IOM -r Telephone: 2 t <br /> Reporting Agency Name: <br /> Agency Contact: Telephone: 204 9�8-3`131 <br /> Address: /,/ilS N• SA�c Tb.44c�� H 3T', Svu�told �� 4S2DZ <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 192R6' EY P440kO SToc�7aL� <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: //AIANDW t[ <br /> Date Notified: Time: <br /> D. RESPONSIBLE PERSONBUSINESS <br /> Name of Business <br /> Contact Person: V,55 Telephone: (Zt ?) 427 <br /> Physical Address: 75R5'i E. ft-opew-& Avg • O-Z,�;p dvc.da, c/3— aozyD <br /> E. DESCRIPTION <br /> Type Release: AaK -Av <br /> Volume: <br /> Chemicals: 6weLlL 24,22-1 4`-(c lata, <br /> F. ACTION TAKEN <br /> So2G. r•Qo.t-i -rW(e 2E�/ovc4L �t[xIIG a7T- So c c- <br /> Lan!r7tls�uJad 7'tnn/• -ice �ss�lv��� dE R�Qvca6�o ro <br /> r 14F-W4gUAF Ml� FXTEc�!'/�oF ETsurcnL�{91c7x/ �S <br /> /�cv REe7 e3 , -r6oK 14. <br /> Cdntr?!t u (4 4-4'7 �;y-r1- ,a <br /> GVRwaUe (ysT) G< <Y dF 5-7Ct-&7il <br /> EH 22 013(Rev. 02/90) <br />