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iF SAN JOAQUIN COUNTY " <br /> NOTIFICA l''ION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG # <br /> ircle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: I`-I V P6�JGX Telephone: <br /> Reporting Agency Name: _-Pith Wen 14., Sgrvtra, <br /> Agency Contact: kn6eu 1 I Telephone: <br /> Address:_ 4t4�, 1j ., r, 1rn n �� ►, Jnr 4��{-r,n <br /> C. LOCATION AND DATE OF DISCHAfRGE <br /> Location: a El- of I / . <br /> (Best Physical Description) (City or County) <br /> Date of Discharge• Uk <br /> Date Notified: 12A on Time: ,_ (l CY'tir,Lv,•+ <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business 4y eQhIMC <br /> Contact Person: <br /> ),° Telephone: 21 1-3 �- 1 <br /> Physical Address:- <br /> E. DESCRIPTION <br /> Type Release: 1)A g CUamgnnnU rigi-einA. t .0 �p <br /> Volume: <br /> Chemicals: ;nl � <br /> F. ACTION TAKEN <br /> ►'aE-110r' orf P� Cl 'mar+rf- ul'o.I1fe. <br /> �G M-t-1 irP ea& I0 0 0tO.YYILLYL�bn(-\ n S022 z>> Eed <br /> EH 22 013 (Rev. 02/90) <br />