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N%001 <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTI-I & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:ID II III PHS-EH LOG # 6 (0 3 <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: <br /> Telephone: (121) <br /> Reporting Agency Name: t �C`R+Gy�,i tJ1C kd�nsc l <br /> Agency Contact: Telephone: ( ) 4�,,Y, - 34.¢.1 <br /> Address: '�c'L I r w'�;► -rl, .T <br /> C. LOCATION ATTD ,DATE <br /> )DISCHARGE , <br /> Location: pv, ,,, <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: l.usi t�-Dt, d <br /> -, Date Notified: �n �q <br /> Time: <br /> D. RESPONSIBLE PERSONMUSINESS <br /> Name of Business V-1'E.1u,U i r� � <br /> Contact Person: Al-M f?-f���L1- Telephone: <br /> Physical Address: A �,?f <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: l,4,1- w �j <br /> Chemicals: <br /> F. ACTION TAKEN <br /> EH 22 03 (Rev. 7/89) <br /> aJI T M, –A Gn-_tV.0 Nl � I S ?j ar f-AL) t bCS Pte' 11AI,j 1�9 v4A: <br />