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SAN JOAQUIN COUNTY ` t` <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE O�n <br /> HEALTH & SAFETY CODE 25180.7 <br /> � U <br /> A. EMERGENCY LEVEL: <br /> (Circle One) l/ II III PHS-EH LOG # <br /> B. SOURCE OF INFORMATION <br /> Original Source:\74-Z E. ��m 5-rock Telephone: (�);7 <br /> Reporting Agency Name: S4AI ✓O4Quin/ �m pZi o//G / S�iLf//CCS <br /> Agency Contact: 001Vni //�fJ-r✓ Telephone: <br /> Address: 6 O, Ra >C )- 41 <br /> C. LOCATION AND DATE OF DISCHARGE / <br /> Location: Li o3 Al, //A .C7 L 37� <br /> (Best Physical Description) (City o /County) <br /> Date of Discharge: UA1,,(t90oyn/ <br /> Date Notified: /- Time: /L7 <br /> D. RESPONSIBLE PERSONBUSINESS <br /> Name of Business UA10e- Z- B!/L /L?+IVT �07def <br /> Contact Person Telephone: (9%6 ) ��/�—91F1 <br /> Physical Address: 7 72a- 2T376 <br /> E. DESCRIPTION / t <br /> Type Release: V � <br /> Volume: VAI ICne,6y /J <br /> Chemicals: 'frn 1,,-z,.,,n y alnoe: 4AAoy <br /> F. ACTION TAKEN 15- <br /> /eSUL /S <br /> erg/'Ya G)'e �i /'G��/vr ✓c/ 0 /2 <br /> d e reo�,i �C n/ c',¢m ire 7 Le- <br /> b1 <br /> tby The 4445! �i � D19eti �S/ . <br /> EH 22 03 (Rev. 7/89) <br />