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c <br /> ..w, SAN JOAQUIN COUNT <br /> Y � <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVE II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: _('64e< z,,,` Telephone: Vi6�-31,Ygo <br /> P (�d4 ) - <br /> Reporting Agency Name: jAr,c -7-Cf-11 I rgtij c 4,( He,,/A <br /> Agency Contact: l;�ar lr Hto,, Telephone: (ate !%2 —!w <br /> Address: --PO- Ray -,�Doq S4o/'kf0,-- <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 16Hl t <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: _-_ /./1 A/r-YA - ' <br /> Date Notified: Time: ,[, r 2 <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business Gahm I f-,' :ZjZ,,.-L �n <br /> Contact Person: _C%r#?,J 6:OA.11, Telephone: <br /> Physical Address: IG 29 <br /> E. DESCRIPTION <br /> Type Release: --1449 <br /> Volume: /J <br /> Chemicals: _ P �, (►�/.r,,. <br /> F. ACTION TAKEN <br /> ���--rN1�K R{��Of/O. I �nrl -1SC(MrA1/9N�3 r ,i/A- rpt' 1cr,,h- ill <br /> TL4r Nr Si 11 C3S/�f'S'/rYll�n-T 16P /`Psc.t��n/ �� �Pf�r[MtIP "T�iP NG►?i/�P <br /> GAl ex .,'� oT ,�07 aN as P P <br /> EH 22 03 (Rev. 7/89) <br /> 1 <br />