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SAN JOAQUIN COUNTY <br /> ( NOTIFICON OF HAZARDOUS WASTESCHARGE <br /> J , EALTH & SAFETY CODE 251 <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORM)ION <br /> Ergco� rPoi� <br /> Original Source: y733 t-1 s:err9 0oo.0re k Telephone: Zo% <br /> FYSno <br /> Reporting Agency Name: <br /> Agency Contact: Telephone: (_) <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: <br /> Date Notified: Time: <br /> --D <br /> D. RESPONSIBLE PERSONBUSINESS <br /> Name of Business /�f�� ����Q�S � /�✓� '" " ���� <br /> Contact Person: X/0" yd oA Telephone: 3G X775 <br /> Physical Address: 26 50I <br /> E. DESCRIPTION <br /> Type Release: LLQ 4 <br /> Volume: v�� o✓n <br /> Chemicals: <br /> F. ACTION T/AK-EN / <br /> A14CO/l uC�t'd � GYf'1 y,-el%!e- <br /> t�C �i 2' PK sI DoT /�PY/c <br /> � �AvreS�C.JJ�U/1 �✓v`�I +' �C�SS�/ � c/%'�/�1r�E <br /> 4,22 013(Rev. 02/90) <br /> a <br />