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SAN JOAQUIN COUNTN" <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVELQII III PHS-EH LOG # � <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: _('{lcrr c ,ti f Telephone: <br /> Reporting Agency Name: ✓,17,7, iN (ru,.j P<h1;r Reef/,I% St'rwres <br /> r <br /> Agency Contact: Cl � f�, rt Telephone: (2 _'i'"' 3yV/o <br /> Address: _ PorA 975--26/ <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 13.Z S -r borw1v 5'd- / <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: __ U k~OI <br /> Date Notified: _ /0/x r7 Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business Sfo k h n, t�a F+^xy <br /> Contact Person: Sob u N Telephone: ( 07 ) -9y8'— //0/ <br /> Physical Address: 632— <br /> S Qa c! Sfi sf Fa,, <br /> E. DESCRIPTION <br /> Type Release: u A1L <br /> Volume: <br /> Chemicals: /r,Iveaea 9rrsa/,NP <br /> F. ACTION TAKEN <br /> TQti+iC ._ins Prr. IQc� (%AN�9U -In io -�ut(<c� OTCCIs/ani �' T <br /> o4n/1-16,- 4 rnl <br /> EH 22 03 (Rev. 7/89) <br />