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N.. SAN JOAQUIN COUNTY `-' <br />NOTIFICATION OF HAZARDOUS WASTE DISC G(o <br />HEALTH & SAFETY CODE 25180.7 10000�� <br />A. EMERGENCY LEVEL II III <br />(Circle One) <br />B. SOURCE OF INFORMATION <br />PHS -EH LOG # o + 7/ <br />Original Source: I HCitAA,5 G GFl-7 1 ?S-'5 7 u-4%iZik Telephone: Z -U ) <br />Reporting Agency Name: f u i, I i? l+E/tl,7H SgFy-0z f5 17 SAN :TOA <br />Agency Contact: Oo N N A [jr_P g -N N Telephone:Z( � y/ <br />Address: A o , 6oX -)-oo 0; S7"DGLCLu, , GA /&70/ <br />C. LOCATION AND DATE OF DISCHARGE <br />Location: 31 L100 j, f <-b 4, �—Te. L4 / / p®c'Z-� 621 1-(--776 <br />(Best Physical Description) (City or County) <br />Date of Discharge: L2V1'170c✓ iv' <br />Date Notified: (? I Time: ' O M <br />D. RESPONSIBLE PERSON/BUSINESS <br />Name of Business <br />/V1 t1% R!/SffL /V[ &-/1-00 <br />Contact Person: <br />Telephone: <br />Physical Address: <br />/ 4�0 U S . /� �s� i� �•y %'` ��/ <br />, G� 3 <br />E. DESCRIPTION <br />I <br />Type Release: <br />Volume:UN IC v� o w ✓t <br />Chemicals: Li-Clso/%��P- <br />F. ACTION TAKEN <br />v <br />6\ ;LL Cie ree mii <br />ad h <br />�e.l e.yJ,, �. <br />fz�r_ <br />�. ,. ►� vr� a,, ,� n�,r•+;2-L, f <br />0 <br />.66 S *w'-.*L� �,. � `In <br />k � � <br />4"f., 2 G, h n -, n r [',A iu' <br />(\oy, /:i /Li <br />EH 22 03 (Rev. 7/89) <br />