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SAN JOAQUIN COUNTY <br /> NOTIFIiTION OF I-IAZARDOUS WAST�JkISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 /7 <br /> A. EMERGENCY LEVEL `I 11 III <br /> (Circle One) PIIS-EII LOG # <br /> B. SOURCE OF INFORMATION <br /> Original Source: fe r o H Tu C k`. ,-, Telephone: a(�9) 3 –3/,;r,/ <br /> Reporting Agency Name: Sc?,K J100 tip.- /�/,GS_ /_ /,! y •v <br /> Agency Contact: Q y f � <br /> Telephone: <br /> Address: P0• aao 9 <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: D 4orcl�/nC �� S �p <br /> (Beat Physical Description) <br /> a /a I l g n (City or C nry) <br /> Date of Discharge: —_ <br /> Date Notified: <br /> D. RESPONSB3LE PERSON USINESS Time: <br /> _ 3 n �vr <br /> Name of Business <br /> Contact Person: Lj <br /> Telephone: <br /> Physical Address: e S u <br /> E• DESCRIPTION <br /> Type Release: <br /> Volume: 1f D <br /> Chemicals: %o .� <br /> F• ACTION TAKEN <br /> .5�a e K/es Sets a.4� <br /> r Or <br /> as <br /> 1 I g"SS UL.;,lo c K A0cl, <br /> IrTI2 nil (Rev. 02/go) CI�JPf <br /> I <br />