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r <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE " <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II . III <br /> (Circle One) HEALTH DISTRICT LOG # 8`I-Gr2e <br /> B. SOURCE OF INFORMATION <br /> Original. Source: �s <br /> t 2 ice. �Q��� Telephone: i 24 —ZT Z <br /> Reporting Agency Name: _5 ¢4� T �;/ <br /> ��Q.l.{/ L-ouq-L, .ALT t3 i ST2.4 C_'T <br /> Agency Contact: 1 / e^,t4 S <br /> MEVrr Telephone: ( ) �f�j-3 �2TJ <br /> Y <br /> Address : 0 o <br /> ra a - C�-�.t✓ Gly GrSZo / <br /> C. LOCATION AND. DATE OF 'DISCHARGE <br /> Location: V �i3 j _ Lock kprof (Ak 2? / �7G��7a� 401_ ���j� <br /> (Best Physical Description) (City ox Countyj <br /> Date of Discharge: IJNi<04ipN,I <br /> Date Notified: --/7 <br /> Time: 1� <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of- Business , mr,- /G/-A AV11 46� D �QCIA}7oz► <br /> Contact Person. <br /> • ,�-L- L4KE Telephone: �ZV <br /> Physical Address : . g� t V d 60 u P,- ,S-,rUG,4E7drr ll��1S"Z�1G <br /> E. DESCRIPTION <br /> Type Release: V^! pt{^ �-tsti0 P-1Zt= b �2 y� <br /> Volume : U N kL►.0h/ <br /> Chemicals: U <br /> F. ACTION TAKEN 'XP_e_o—.; -Gp rg.; ,., pj$ o ,+ /'t FAS Led IL �s <br /> e," <br /> 4n/ l4lOo0 ,�.s..d /Zoao �-a I/e.✓ (/.vq/eryrrr�hc� �soL�:� .Sy`3�ayP fr,�+�x. � <br /> h <br /> F71.,eHj&1, 5c .4 5e5� � � w,•L L tae r,• r rem/ <br /> es <br /> ,fl_ _ _'�'� <br /> I vl e ija-1 tee._ lLv� /� <br /> lc Q.�C'�P.w�" 6 Cru►V TA M it,' ArT/O r1 <br /> P p v'6 py A 1-e e i.c L/ h <br />