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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 HEALTH DISTRICT LOG # - /C) <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: G6.S, -,}(y"t Telephone: (ZJf ) qy /- 7,116 <br /> Reporting Agency Name: S.J•L•1+ b. - i�-9. <br /> Agency Contact: kAwuC tlltlnl� Telephone: (zm) y6y-3YZ0 <br /> Address: PG.l3a}L 2005 STKw Q.-Z.o/ <br /> C. LOCATION AND DATE OF DISCHARGE / <br /> Location: � w )�dzzl� b 0 . Sf / <br /> (Best Ph sicalDescription) (C4 or County) <br /> Date of Discharge: <br /> Date Notified: Time: IlaA-0v <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business <br /> Contact Person: bcr .-. (Sc- C�X� -snN Telephone: <br /> Physical Address : ,17(// z)/) XeU( <br /> E. DESCRIPTION /// �" <br /> Type Release:L !�(/K/�i.(MA /Lt—l"-e-,{i��n i rvLS r vu�y� <br /> Volume: .�� If/ri� - 11lJL/L rrQO <br /> Chemicals: <br /> F. ACTION TAKEN <br /> -TlLe-- 5P'1/ occ �rrec( o � arourt�� stcrF < 2• rd d�air <br /> . i n-(z o /— wa� e r se,>G r� r �I Re �er ra Qs mads -F0 <br /> a-od P0H S -T.Sc.o fil- -F01- u, Ly cts pct-rt <br /> D� ("n clkic� aSs ,�-sskrw"?-f� <br /> COPY <br />