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SAN JOAQUIN COUNTY i- <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> 13EALTI-I & SArF-TY CODE 25180.7 <br /> A. EMERGENCY LEVE I II III <br /> (Circle One) PHS-EH LOG # <br /> B. SOURCE OF INFORMATION <br /> Original Source: LLCL <br /> �� Telephone: L20c, ) <br /> Reporting Agency Name: crrjcar fin,, �f' �f / <br /> 17F'U/�ji �U/CPS' <br /> Agency Contact: C'llgrh S NTelephone: <br /> Address: i . n C-- <br /> C- <br /> C• LOCATION AND DATE OF DISCHARGE <br /> Location: n rJ . �. .,r <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: UNkNw�j <br /> Date Notified: I/ZfI <br /> Time: 2'3() f* <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business 4 ockTO,� (An/FF7�n Sr�ooL �t ,ple�— <br /> Contact Person: _(-L"� '/p.. 4 '4 P Telephone: (267 1 �yy —yp7g <br /> Physical Address: 300 Q 6er4-g An Sher k-FoAJ <br /> E. DESCRIPTION <br /> Type Release: UA12 <br /> Volume: e l"-i 'IlfA ,1 <br /> Chemicals: G(' n1ra-e <br /> F. ACTION TAKEN <br /> < rp /cam, 1 A t—^ h r� <br /> u �rfv. Pr wiwn �" iv' 11 ho <br /> Pie- <br /> �i�ler��A r•/c>r�-t^%fr' <br /> EH 22 03 (Rev. 7/89) <br />