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SAN JOAQUIN COUNTY <br /> NOTIFII� CTION OF lIA7_ARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 2518V <br /> A. EMERGENCY LEVEL ii III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: Sp i� c4 tau <br /> AQ �Pr In y- ,iTelephone: <br /> F+o/tom Cly Fiiv,.c�r7,7erl�/ <br /> Reporting Agency Name.- �� 00, too <br /> Agency Contact4rze/.✓Id/ Telephone: ( e ) 3 ysf <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: eS77/ S /✓ -G,�f�;�� / Cr <br /> (Best Physical Description) (Cit or County) <br /> Date of Discharge: <br /> Date Notified: Time: - 92Dl" <br /> D. RESPONSIBLE PERSQN/BUSINISS <br /> Name of Business <br /> Contact Person: Telephone: (_) <br /> Physical Address <br /> E. DESCRIMON <br /> Type Release: I <br /> Volume: 0117 acylj/7 <br /> Chemicals: o d/G✓� ioC4r <br /> F. AMON1TAKEN yrl�_�/ / <br /> te <br /> GOy/t�Prib � rrvi � �cP/1C1/ <br /> EH 22 013 (Rev. 02/90) <br />