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I <br /> SAN JOAQUIN COUNTY <br /> CoD NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> p 111$'AL'I' 11 & .SAFETY CODE 2511 U . 7 <br /> A . EMERGENCY LEVEL : II III 111 ': ALT11 DISTRICT LUG II <br /> ( Circle One ) <br /> B . SOURCE OF INFORMATION / <br /> Original Source : iC , rl,v� rl ml r(�or.0 I �yifGlelep}one : <br /> , <br /> Reporting Agency Name : Gi�LJrr" CZn rsrr' ,r 'f" <br /> Agency Contact : h' f )t( urili„k , Telephone : ( ? Oye ) <br /> Addzess : I Irr71 0 tet. StL rJ <br /> v <br /> C . LOCATION AND DATE OF DISCHARGE <br /> Location : F=16C- HT ,kILL Raaf_ / �i / r , ) •r <br /> ( BestPhysical Dcscri Lion ) ( City 01 CUUnC <br /> y ) <br /> Date of Discharge : <br /> Date Notified : — � rry� Time : <br /> D . RESPONSIBLE PERSON / BUSINESS <br /> Name of Business K M <br /> Contact Person : I`I1 _ rVV ,r Ta . Telephone : ( ) X 51 - DIc <br /> Physical Address : I I L530 (Aj . 6 rv� i L <br /> E . DESCRIPTION (� <br /> Type Release : �,� vuLLI � ItGfirrr� r, , <br /> Volume : jt�1 klt � wni <br /> Chemicals : /) <br /> F , ACTION TAKEN <br /> t'I I �1'�\t� Si r1 (1S�'�Srl'lfJ ,. 1' I :1 ) •. II � ( Pl f � ) : R=C} 'T� ('� �-i-(' x! '11 r ni O �( V• <br /> rY1 7 . re PiXtJ n T �f �/ _ Vb (� ,)/A CJ-1 n L 1 ) re(wf � 0 t� P <br />