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SAN JOAQUIN COUNTY`-' <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:0 I II III PHS-EH LOG # go - ag 9 <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: _ (-Grit{;; /qca f Telephone: 2ocj ) L,S 3YN0 <br /> Reporting Agency Name: -.r-0 0A <br /> Agency Contact: _ ur(is Hu. 1 Telephone: w ` q-3qub <br /> Address: L9. /?ac 2ocr? 'Verk o-d (-4 `)5,201 <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: /97633 r. a, gfl / rloMt"fs C!+ <br /> (Best Physical escription) (City or County) <br /> Date of Discharge: 0k"txv" <br /> Date Notified: I tLay f 4o Time: F o Am <br /> D. RESPONSIBLE PERSONBUSINESS <br /> Name of Business C femrJs Service. <br /> Contact Person: Telephone: ,c <br /> Physical Address: <br /> E. DESCRIPTION <br /> Type Release: -- (AX(L <br /> Volume: U <br /> Chemicals: t�e--,r t _ �err�°�uw lvcfrorr,rGc�s <br /> F. ACTION TAKEN <br /> S',Ie RSsrSs/mP w,1! bf' rPowr+l -fo �7r /rryN •Ne fn'P rvaf�ry a✓� <br /> i <br /> EH 22 03 (Rev. 7/89) <br />