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SAN JOAQUIN COUNTY •.i <br /> NOTIFICn111 <br /> IION OP I %AItDOUS WASTI- DISCI-IARGE� <br /> HEALTH & SAFETY CODE 25 i�0.7 <br /> A. EMERGENCY LEVEL:6 II III PHS-EH LOO # GJO U <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: Telephone: <br /> Reporting Agency Name: S47✓ v'D11j--&",;V Cor WrV )'o,44,. IkA-t-rid- <br /> Agency Contact _CJ , ,e f IUAklel Telephone: 1__) <br /> Address: -- l?, D , 100;� v S90E� 6,_1:- 9-u/ <br /> r <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: r1s7 //^- 3�d <br /> (Best Physical Description) , (City or 777" ntY) <br /> Date of Discharrc: -7,' 3 0P-7, <br /> Date Notified: <br /> Time: <br /> Z r 'S f' ku,. <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business 1'54t 7/ <br /> Contact Person: Xe 9<2 �J2g2 Telephone: ( /,0qj L3 <br /> Physical Address: 7-> / 57, 7.o? C-11- 9S7d <br /> E. DESCRIPTION <br /> Type Release: _ 7TN,97A t'K OF-i'z <br /> , <br /> Volume: 60 g �.CGvW1 <br /> Chemicals: e�Sel <br /> F. ACTION TAKEN r <br /> A- r i Se)e �*2 <br /> wo e i KL o-A wa s f <br /> G�IAr�ul U s P 5 �o o f d esPi1 ati. _G S phi`' Ow c{ <br /> C� ISO d.. s -wb �Il- tol �cG�/ is _- ra;W5 40 <br /> A V.0 z Gn'd O tA- "A-5 <br /> Eli 22 03 (Rev. 7/89) <br />