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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180 .7 <br /> A. EMERGENCY LEVEL: ( II III HEALTH DISTRICT LOG <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: Telephone: (Z0S ) 466 . 3oi3 <br /> Reporting Agency Name: S •� (_0�.1 ���� ��^ S�vl c� <br /> Agency Contact: Telephone: ( z�� ) 46Y-3440 <br /> Address: I(ooi E. "a7ekAa , P. o. --,Szof <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 1110x Tc. <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: �tikko�� <br /> Date Notified: (afzglkk Time: 1 f� <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business IN��1e� S Va•l T h —nA�� <br /> Contact Person: Telephone: ( 2-A ) 466 5��3 <br /> Physical Address : III"1 cls-zos <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume : r� o <br /> Chemicals : (JaC�olcy Cyd a� �,o <br /> F. ACTION TAKEN y� <br /> V7uv 1-er C � -S1bR-SSw. 1W`..fi 4.•�l h.� YeS�.iJCd '{J dt'�err.,.1•�..i ��`�1vlW -Ve <br /> d``..G 21X�e.�1 �� ft..\�w•�•..�T a.� 4S yC[•..ivCd Li` � 4dO roUl�w'\'� ✓'21..1.+.�Y <br /> - -!nDv Tl..ore•� 1 I 1 1- <br /> ^212.$0- vl�,q G\ -} wQ o� �0.••1( �'C-h,.oJn� <br />