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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> COPY <br /> A. EMERGENCY LEVEL: II III PHS-EH LOG # <br /> (Circle One) <br /> Be SOURCE OF INFORMATION <br /> Original Source: Telephone : ( DY-1 (4 (o (o -q(0�*9 <br /> Reporting Agency Name : N '302: I 0 i n (\,n „nf- , re�pb } c (...E' or e * 5,n l r n <br /> Agency Contact: _ Lrnno. Pa4mk, Telephone: (_�pq ) clloR= 3u2-7 <br /> Address: (v01 E . P192n -rC0 <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: `�) I '7- 1AI . F— ELeokr7- <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: _U �g k OCLLO <br /> Date Notified: -e �a . 1 9 Time: 11 , bon noel <br /> D . RESPONSIBLE PERSONBUSINESS <br /> Name of Business Ctveg1%) fo '>cI- CeFhktFbRb <br /> Contact Person: 1)91) , 1 ) Gn9bzn ; fin Telephone: (DCq ) 410(n -q fn-� <br /> Physical Address: EIS ( A ) . I ern + St-, S-{-tk) <br /> E. DESCRIPTION <br /> Type Release : (,(_n2Uthonzc7r1 rel nntcee tLy UGS dI noern( ) <br /> volume : Un � ,gmc) <br /> Chemicals : Gn �,,nl I noJr <br /> F. ACTION TAKEN <br /> ar rf- IAj r I I Yrent 1 i red to (1ca+erm , nP J <br /> I'1i']-i a rP and extee (-) f- rrnnfi/1 ✓ri 1 rYkf"I On ce ) IrPrl �� i <br /> is <br /> EH 22 03 (Rev. 7/89) <br />