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• (0 <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180 . 7 <br /> A. EMERGENCY LEVEL: I II III HEALTH DISTRICT LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> �eN e �I 11 Telephone: (� 7 y3,5 �" <br /> Original Source: IV15 �Ce ✓i '�T� p <br /> Reporting Agency Name: 5A/V Jd1+Qh4i1-jLaar�C I pL7� y1,S7/ZIG-r <br /> Agency Contact: kGC,s4.vP, Sii/�1/FL✓ Telephone: {2D9) ✓���y� <br /> Address: 1', O . (30�< "0C)L , <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: .�35 S, /✓7�/L -7, / c17oc�7"i/ %�ZU� <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: Vil/!�/i/w w <br /> Date Notified: 3��—��l Time: <br /> D. RESPONSIBLE PERSON/BUSINESS // // /� � <br /> Name of Business PG2L 7T7e, 77,v AS 2,M2 6#1r- 4e <br /> Contact Person: M/kF 6 B/VNFT-T" Telephone: �) qv-? S6� <br /> Physical Address: 3-3E 6 9s�03 <br /> E. DESCRIPTION <br /> Type Release: (l/l�� /17�GlJ/2/Ztt/ {"��PaSFi <br /> volume: U/V // <br /> Chemicals: /o7s9� �lyd2oc 4/L�io ./iS (� UA1L� 44def &tSoG,Kej <br /> F. ACTION TAKEN Q, __ /Z, �vNhv v� � j � le Z74t ✓&d' <br /> ' <br /> - Az �42� C lA eo /i✓i/l 62 I'�91Ai2ed 7�0 <br /> w P TER rn Y'n v -r'A e {i a 4aA re, A. ) 7iki.-4- <br /> Cer T�n. iNEt�oini -lt2, C��Qhop✓ !/l7e <br />