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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVE Lf I / II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> OrOnal So rce:CQI1c{.�1 L0Ob1�rd Telephone: <br /> EXXCn m n : 12c705ini+h , 5+e 2'fZG� <br /> Reporting Agency N�me: <br /> Agency Contact: 1 ary) V lb(� � Telephone: (ZO l ) y�� <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 3l2-40 w , .3en 4&if Dr!ve. 57�CK n <br /> (Best Physical Description) (City r County) <br /> Date of Discharge: u1 Known <br /> Date Notified: 5/2319/ Time: 3 DOOM <br /> D. RESPONSIBLE PERSONBUSINESS <br /> Name of Business C /� <br /> xxt)n l .6fYtT� <br /> Contact Person: ri r Telephone: <br /> Physical Address: I-ZO `JM I4h , 51 e, <br /> E. DESCRIPTION Pn' ,�Ux L1UiS I1ou5t�n , �x � ZIO <br /> Type Release: (AnKnOwn <br /> Volume: UWK n w n <br /> Cheicals: I ne h-)CAO r -CVe.1 <br /> uc�,5ur aee laves+Iqa-hen re,Uzc,m z -YAC\cOCY, n mEn 1aY <br /> F. ACTION TAKEN W l is <br /> u r44tav Gly SS bT+ L VYU 'Yl <br /> � I IPl h b2 L na LI LO J A1> LAC 'LL- 'yy" n CL A lisp- LI Ved <br /> r l LCA <br /> EH 22 013(Rev. 02/90) <br />