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r1 <br /> 1 ` <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> I-IEALTI-I & SAFETY CODE 2S180.7 <br /> A. EMERGENCY LEVEL II III PIIS-EH LOG # - 90- 03 6 <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: A Ae/r;c-s jr�c eryv/� Telephone: 15 ;7 -CiGUv <br /> Reporting Agency Name: �� ��'�� ' ►��� C �,J,�/• ��/5• �� <br /> Agency Contact: ,--�/�%/-7,i Telephone: ZCxi L �- Z�/ S� <br /> i <br /> Address: O/ .54�,r- <br /> C. LOCATION,AND DATE~/OF DISCI-1ARGE <br /> Location: ���9i z 3 >- ?c,�v 0,.:/.3 o�v y3/- --77— <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: — c1-L? A nom; "l <br /> Date Notified: 5;76; Time: _3' <br /> D. RESPONSIBLE PERSON/ <br /> /BUSINESS <br /> Name of Business <br /> Contact Person: <br /> Telephone: -vf 3 <br /> Physical Address: -- 73/7 G,/ <br /> E. DESCRIPTION / <br /> Type Release: S'� c �r i�:.��he '�I CC,v 4/e'W1 (.b Q SC:) <br /> Volume: <br /> Chemicals: 1""ll <br /> F. ACTION TAKEN <br /> / •� �� C•5���S /�c joss; ';�� '�; c,� ,nom;�� �� <br /> 0- C( Coll // <br /> r' <br /> 131-122 013 (Rev. 02/90) <br /> i �� <br />