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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:0, 11 III PHS-EH LOG # /6 — O q p <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: Telephone: (,20j) X38 -j5d7 <br /> Reporting Agency Name: ( purl iL P�l S - RID <br /> Agency Contact:(::�-7e4,,L o �,� ; Telephone: <br /> Address: /��cl�� <br /> C. LOCATION AND DATE IIOF DISCHARGE <br /> Location: �c,n ner [ S)4e�rd <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: - _ y Yi O cJ 4 <br /> Date Notified: Time: <br /> D. RESPONSIBLE PERSON/BUSINES <br /> /S <br /> Name of Business /'�` 4D,7 Ob ✓lm�4+ <br /> Contact Person: _ o� ��� ` Telephone: r �G�y oc-SG <br /> Physical Address: Hc, LI Sfoc,��� G y 5 20Z <br /> E. DESCRIPTION 1 // <br /> Type Release- -- a rl rH O✓� C Ca> K'/C ' v i�, �r r( <br /> Volume: u <br /> Chemicals: e-u n <br /> F. ACTION TAKEN <br /> 74/ <br /> i <br /> �- <br /> EII 22 013 (Rev. 02/90) <br /> i <br /> I <br />