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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 PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: CR WL,-�C o Telephone: (9 6 3G 50e) <br /> Reporting Agency Name: <br /> Agency Contact: Telephone: <br /> Address: Lc-*"o/ <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: -�&y60 S' ��'�,4 <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: v91 <br /> Date Notified: //-_-.7/ -5 Time: <br /> D. RESPONSIBLE PERSONBUSINESS / �► <br /> Name of Businessl�' �✓� ��c�i / C �n?�Js✓�y <br /> Contact Person:` , 5517 -z 5,�. Telephone: ( � i) X35 - s%-?3 <br /> Physical Address: _ 2&76e) <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: ��✓� <br /> Chemicals: <br /> F. ACTION TAKEN <br /> 4:° 12 Ski r J ,Gr , G ,— c ✓ �r'�� ��� � <br /> `31 <br /> �-tsr°i7f y <br /> 1 <br /> EH 22 03 (Rev. 7/89) <br />