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SAN JOAQUIN COUNTY <br /> NOTIFICATIW OF HAZARDOUS WASTE DIOIARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: 0 iI III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: Telephone: <br /> Reporting Agency Name: SAM 7°'44"' tq 19vBt-4L 14EAQ-r74 SE�vlC£S <br /> Agency Contact: AiPlL —5,dE✓EnV^L Telephone: 4 k-343 y <br /> Address: Z/4!S Al- SAn/ <br /> C. LOCATION AND DATE OF DISCHARGE � �� <br /> Location: 223o E_ <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: UN14V&+,�N <br /> Date Notified: //ZG((a( Time: 9-30 2411g - <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business AV7V <br /> Contact Person: AtVoy GoDEZ- Telephone: (2�) <br /> Physical Address: ZZo4 E h1 4 S?acl�'rDN c-4 26Z-05 <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: <br /> Chemicals: XYuEN � <br /> F. ACTION TAKEN SoiLS9,N�lcjS Kc3vL7S � vayn�� v�vea(!t�/�si <br /> Fv,QTif�.� Sly ,QXFf,.i4E�tT 4i/GL �3E �/EGESS�f' � ` <br /> j�6 ,Pcr/MJF 71Lp y1*7 ,eA 4K-6 E tl7 �F co .d��N�z ions <br /> ,45 <br /> EH 22 013 (Rev. 02/90) <br />