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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> C(apy <br /> A. EMERGENCY LEVEL: II III PHS-EH LOG # 611' 17 7 <br /> (Circle One) \ <br /> B. SOURCE OF INFORMATION <br /> Original Source: Ny lzotd Telephone: �-1 ell <br /> U - <br /> Reporting Agency Name: <br /> Agency Contact: fcNo� Telephone: t ) = 344 <br /> Address: 0, � <br /> C. LOCATION AND DATE OF DISCHARGE . <br /> Location: 13,q <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: <br /> Date Notified: -7�so f i Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business <br /> Contact Person: _('U 7.t; (L(X� � Telephone: (2�2 <br /> Physical Address: —261D OPrK!t30 momE. DESCRIPTION <br /> Type Release: � c�Lv�Jts CcN1 S ((�,c � lt�1 �22_>> �wn. (�lj• <br /> Volume: — I W 4li <br /> Chemicals: (iRf<Qt..W'C <br /> F. ACTION TAKEN r <br /> f-lj TIAO( ��� c�.7T 1 <br /> EH 22 03 (Rev. 7/89) <br />