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,lam. ,. <br /> �- SAN JOAQU I N cowry -4 _ r <br /> NOTIFICATION OF . HAZARDOUS WASTE DISCHARG <br /> HEALTH & SAFETY CODE 251$0 . 7 <br /> .A <br /> A. EMERGENCY LEVEL: I II III HEALTH' DISTRICT LOG <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: ICI_. �N1lll�L y Telephone: Q? )y K.-7 `f4ic1 <br /> Reporting Agency Name: <br /> Agency Contact: . Z Telephone: (2�22) <br /> Address : r' 1l. -- TNCX[r • <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: <br /> (Best Physical Description) (City of County) <br /> Date of Discharge.: ... <br /> Date Notified: Time: <br /> D. RESPONSIBLE: PERSON/BUSINESS f <br /> Name of Business (/14LG�c`*' NU4� �i �1�►i*I'i4� �' _- __. <br /> Contact Person: �j ���jf � � `i'elcphone:- ;7: <br /> Physical Address : � 'STCK <br /> E: . DE•:SCR I PT ION <br /> 'I'yEJc ILelease. <br /> Volume: <br /> Chemicals . <br /> I <br /> P. ACTION ON TAKEN <br /> I If <br /> x _9kA f 1r7� IILT"OE<22R ..,L-7r s; " LlluLEU 8c7 r <br /> - ; <br /> l <br /> S <br />