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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL II 1II PHS-EH LOG # CO — 0/ 7 <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source:MALIP5 NU,j-� Telephone: (.ZQ�L) 3qw <br /> Reporting Agency Name: S1rIJ ��rn7u�n> �euu{y P 6b; f/�N/� Si�rciiePs <br /> Agency Contact: Telephone: (� I —3yya <br /> Address: �? C arffa� vP Sf� oN � s <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: _23 569 13� Sn.,44 Fe P,/ <br /> / 6uprlrxiri <br /> (Best Physical Descri tion —�— <br /> P ) (City or County) <br /> Date of Discharge: —L�,-/Vkra rj <br /> Date Notified: l f2 Lip Time: l :00PM <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business gq✓Jc� <br /> Contact Person: Telephone: c 1/12 <br /> v <br /> Physical Address: -2 S c74 T 1775?„J,- <br /> E. DESCRIPTION <br /> Type Release: e41 /9,(,r <br /> Volume: <br /> Chemicals: <br /> F. ACTION TAKEN <br /> erltiF� sits els/<rsyHr3� �ti>l// fX' lrr�uiir� � -7 <br /> GOD/b1�i3'itel TFrt�/,frnr� G�'i/'n��Y�' <br /> EH 22 03 (Rev. 7/89) ' <br />