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SAN JOAUNTY <br /> Q <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> Health & Safety Code 4 25180.7 <br /> A. EMERGENCY LEVEL II III Health District Log # <br /> (Circle one <br /> B. SOURCE OF INFORMATION <br /> Original Source: VN KNOI.IPI Telephone: (_) <br /> Reporting Agency Name: nEiL:TA -TR-UUk L1 N � <br /> r '� <br /> Agency Contact: �� ( SY11 i-/' Telephone: , 6L 6/ <br /> VIA O_Fr DaRo'1J7i}y' 5ZAA10 <br /> Address: 3 C c F—r cka4 .o k-*. 20(�, <br /> C. LOCATION AND DATE OF-DISCHARGE <br /> Date(s) : ; — 9 / Time: 7D.m_ <br /> Location: 36SS— F ok 2d . S'�,U/ <br /> Best Physical Description) (C ty or Count <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: IZ-kL-l✓iy ,dz✓i <br /> Contact Person: Telephone: (_) <br /> Physical Address: <br /> E. DESCRIPTION <br /> Type Release: SAL <br /> Volume: <br /> Chemicals: <br /> F. ACTION TAKEN <br /> -"�l4� <br /> Q FG <br /> G✓��lt , 1,V19 9 Ar ve /h .,1 a a s <br />