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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: ( II III PHS-EH LOG # 3E <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source:1,I)AR/Z vL66 ,erS7,AO;6' 'elephone: <br /> Reporting Agency Name:.Win/, T , v p /?, /�� <br /> Agency Contact: -DU1✓1v1f /-16f2 /P-7�/ Telephone: ,00 <br /> Address: r 0 60 )< a7UG�C7c�i✓ 6A <br /> i <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: S�S /—�' ///—'i / 7�,Oq-661, 6^ 76 <br /> (Best Physical Description) (City o County) <br /> Date of Discharge: �7111..i/✓ <br /> Date Notified: ZU Time: <br /> D. RESPONSIBLE PERSONBUSINESS <br /> Name of Business c� /YiGfG�L S`zv <br /> Contact Person a 2tZy L CHP-15JO e ephone: CLO± y62-6 72� <br /> Physical Address: <br /> E. DESCRIPTION <br /> Type Release: �!}� <br /> Volume: /�i✓/�ii���✓i✓ / <br /> Chemicals: fVie,04�9 S <br /> F. ACTION TAKEN <br /> " �yiL ,4,✓/or1G✓fi-7,�;e /�.�i� /'�sorf� Yp ✓e�� LCon/ �l/� /��ifia4 <br /> !'�,� �✓u� o ,✓ /—i y 90 F�2f1�i` t iia �'sse�s/-H �.�' <br /> �x n Gon/7�7it,/` gn/ <br /> ell�Oi Y9 f0/YCl� GL�r?iyt Gi/ <br /> EH 22 03 (Rev. 7/89) <br />