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C Y <br /> SAN JOAQUIN COUNTY <br /> NOTIFICA'?TON OF HAZARDOUS WASTE 1CHARGE _ <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:a II III PHS-EH LOG # f �17 <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: A14 -T—� Telephone: Z -7g <br /> Reporting Agency Name: <br /> Agency Contact: Ti¢ yF�cta� __ Telephone: <br /> Address: 4t yE N• $44%4 'L.¢nL.1 1 rt <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: l/� n <br /> Date Notified: 1516 Time: <br /> D. RESPONSIBLE PERSONBUSINESS <br /> Name of Business "-dam <br /> Contact Person: U15;� Telephone: (gt ? ) Z <br /> Physical Address: 15, LO � <br /> E. DESCRIPTION <br /> f Type Release: p u e s <br /> Volume: w- <br /> Chemicals: •<<•� 24"s0-! A"f"l /e-'2 <br /> F. " ACTION TAKEN <br /> Canl�7t?.ccu�! �!i 55 lri�Gc. �' v: D -40 <br /> Gds�ccl.¢-gip �� a (C t, �v . a-.•�� ,'� 1��5 Q'Sc <br /> EH 22 013(RcV. 02/90) <br />