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i <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180. 7 <br /> A. EMERGENCY LEVEL: �L�' II III HEALTH DISTRICT LOG #6���1s <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: Tir.;ryCM Telephone: <br /> Reporting Agency Name: c )A4Lj -i-ya -l" /;rsll <br /> Agency Contact: /? +�r f:'tiill= Telephone: <br /> Address: fC% tCC/`� 5fzr/c/�2h 93 Jo/ <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 6c-) <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: <br /> Date Notified: Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business 1116')eLeSA-j <br /> v <br /> Contact Person: /elllelc, Telephone: (-W6 6jg <br /> Physical Address: 1-yi <br /> E. DESCRIPTION <br /> Type Release: <br /> c/ <br /> Volume: <br /> Chemicals: <br /> F. ACTION TAKEN <br /> c'Y �•JC'' te:,' Cc` i{•.�rcC-�� t`''-l/c'i(C�ti( �d/� �+l��P���l/12p� 2U.�ei�/ <br /> Llx 92'lr[1 r✓ � SLC' ct���y <br /> ee .oCPC� <br />