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� SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVE I II III PHS-EH LOG # - q/-4V <br /> (Circle One) y <br /> B. SOURCE OF INFORMATION <br /> Original Source: _�!kn Telephone: (zo? 3e7W <br /> Reporting Agency Name: !Wjj �: ►��,.� �.� P.�b Aee#A S'Pn%cPs ENv ffPu/f�i <br /> Agency Contact: ( A tn6�s �{,,,t" Telephone: (Zpq ) 469 -3'4/'fy <br /> Address: ���Qc .204R 24tiC.�e-1N �- 95^n <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: -2,50 -7 '.,y,/ils-fr/�t,� <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: U N k-iJ0wr4 <br /> Date Notified: 2&,-g-10 Time: <br /> r--,D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business _ _L_r_ar7a n) - P4 4r Fry <br /> Contact Person: P F Telephone: ( Q2 _-R3y <br /> Physical Address: =6o Lc, 1- 4 <br /> E. DESCRIPTION <br /> Type Release: ___ UAL <br /> Volume: U�KNQWj,) <br /> Chemicals: 1� rzr.►rf�or� <br /> F. ACTION TAKEN <br /> ��( <br /> �C'N'L �S �P�'�' O.� � �r'lw Gt"to�✓r �41�� S'L�r� <br /> r�e5r,l#s <br /> EH 22 03 (Rev. 7/89) <br />