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SAN JOAQUIN COUNTY <br /> NOTIFICAI1"N OF HAZARDOUS WASTE Dare.°HARGE <br /> OF <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: 91, <br /> II III PHS-EH LOG # <br /> cle One) <br /> B. SOURCE OF INFORMATION Telephone: <br /> Original Source: AIFZl 1 , —E� qF ��i NE P <br /> ZG---O ojaim2&cam, d-t -0 . PLdcAaa) SRS Mf", Cc� Q'41-(0Z <br /> Reporting Agency Name: <br /> Agency Contact: A Telephone: ( ZCFi) �oRCog_— <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 1 i <br /> (Best Physical Description) tY r County) <br /> Date of Discharge: LVI-<21 <br /> Date Notified: 5-2 q I <br /> Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business <br /> - <br /> Contact Person: Euzb or EV rAE Telephone: (-4-1!D <br /> Physical Address: 2 A� � t1� —� hMR�o. QO2 <br /> MRtI.uucr D2eSs: `1p'.0,3cyc 5811 SArJ MA g4-(OZ <br /> E. DESCRIPTION <br /> Type Release: 1r <br /> Volume: <br /> Chemicals: <br /> F. ACTION TAKEN <br /> Fuel_ 1�3A5 clP-i 1J� life IIJtTN n �Rf1 � ST' �N 1��1h,7su���7 <br /> ��t✓a–� Efh >T S Fltk�� �Y fl2C0 c�RE THIS t�z�r <br /> EH 22 013 (Rev. 02/90) <br />