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a <br /> t �J <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: (� II III PHS-EH LOC <br /> (Circle One) > <br /> B. SOURCE OF INFORMATION " k <br /> Original Source:D4 2/2yLC,�leiS7,n6elephone: <br /> Reporting Agency Name: SAn/ <br /> Agency Contact: Po/,//v/t /'�2 yi✓ Telephone: (ZO%) L/l8 35FZr7 <br /> Address: 60)< <br /> i <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: S // ,o 4-66 <br /> (Best Physical Description) (City o County):, <br /> Date of Discharge: (�iV/��o%.i/✓ <br /> Date Notified: Time: '�F. D e- <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business e2� <br /> Contact Person: LAKs/L C/f)e151 e(1OTeephone: CLO —d ZZLf <br /> Physical Address: <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: /Alxt�Ozr✓i✓ / <br /> Chemicals: ee_7�v lu <br /> F. ACTION TAKEN I <br /> _._Sa/iL ,4,.//n�1/�✓fi-7,�ye Simi. �sGr/�s 1YQ vel,//�Coi�-,�l�i•.,yci/zo : <br /> ���✓� o e✓ /—i9— 9D Fi�2�or�. Sim CSSess/-N �.t' <br /> o;'/_L �J�• y�c3'/,�/ e��/� �P��.¢v�, i�,P � �/ /�rctf/, i /�c.� <br /> 'fix �" D CiCJ/v f/g/ji/ ii✓n.�pr/ /•'L•'c%G/ YJ(/ E <br /> EH 22 03 (Rev. 7/89) <br /> ..r <br />