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SAN JOAQUIN COUNTY Z <br /> NOTIFICATION OF HAZARDOUS WASTE 6119CHARGE <br /> HEALTH & SAFETY CODE 25180.7 py <br /> A. EMERGENCY LEVEL:01 II III PHS-EH LOG # _ 75 <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source:�1 fta✓ ttZNSeoj Telephone: (�)4'l,,6 -345'0 <br /> Reporting Agency Name: hl!Nrq p�5 V' T) <br /> Agency Contact: 1'-- Telephone: <br /> Address: 1 6 l S. t�A��22T�i`� A--it:; STKiJ <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: !7-q0 LeWw tZ <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: IA13y, <br /> Date Notified: L Rl L 2 q$ Time: upy-, <br /> D. RESPONSIBLE PERSONBUSINESS <br /> Name of Business K&S JIFe <br /> Contact Person: dQW MKCA Telephone: ( i } 946-U024- <br /> Physical Address: 2-269 ►-S <br /> E. DESCRIPTION <br /> Type Release: G"f'(1.oL�l ry� Dt?�C/F(LF�9wJS U I.�D�Yt-G-R-0u ND 1»E�- <br /> Volume: Lt <br /> Chemicals:— �t'T'ftE �rw Ll�Racat2r�cnr.�S <br /> F. ACTION TAKEN <br /> �t�l[lTY Z S l I ,&;G I t4,,T_ VJjLL "0U-1 RRt-.- 'Tb 1)G`'iZ50.Y1L1.W 6 jWS N X11 k <br /> lop b<TEPT Gov; x� ►�X1,1 S►J . d,s U&Lk¢t7 ;?,L? Tct&- dF-P 0 W VA rtiz <br /> �C Lk L-ftyue <br /> I)Wn Fi r 4A� I<, to nA r- AT S -n Wt..L= <br /> EH 22 03 (Rev. 7/89) <br />