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s ✓ <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: 11 111 PHS-EH LOG # a S <br /> (Circle One) l/ <br /> B. SOURCE OF INFORMATION <br /> Original Source: /JD/✓ if1AA-,� Telephone: 2d �35 '�ys y7�o <br /> Reporting Agency Name: S /W - <br /> Agency Contact: 049A t//4" /TN^S Telephone: <br /> Address: P/d, g� k ZOD `7 S efl� <br /> C. LOCATION AND DATE OF DISCHARGE �� �'P� <br /> Location: 3©/ Fc (r/eAV774oje/ <br /> (Best Physical Description) (City or Cou ty) <br /> Date of Discharge: �IW4WAIA/ <br /> Date Notified: Time: a <br /> D. RESPONSIBLE PERSONBUSINESS <br /> Name of Business <br /> Contact Person: / If'; di✓ Telephone: <br /> Physical Address: E. 4rR,4 JTG/it/P <br /> E. DESCRIPTION / <br /> Type Release: U�� <br /> Volume: <br /> Chemicals: �t/�b /e ars,. 1 4�Gt��a ��ia�✓S <br /> F. ACTION TAKEN T <br /> yusu/A; g t/ A G Goiv�/�.h lnlft-r�d.� FYo A,, ('�lL <br /> ��arewv� Sfd!/pa� 'fR-n!� t�-.10✓�cf a�./ /!f—Z6-8% y <br /> 255 6e reeuseewe <br /> �o71P�i�is+/see /7Ae 4,g:&ix-t ai62,Gf °XAA1- o� Ldi�`t' <<�✓� <br /> t�Gri,,iQP.� 6t 'fie Cr�brJivorr�/f'e �i�-u-i <br /> EH 22 03 (Rev. 7/89) <br />