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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVELIG II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: (—karre c: (-- ,.,f Telephone: 2224/6L--341/0 <br /> Reporting Agency Name: SL., larg o') CC AA P,,hir*C 16-Cf9A F.�vrrr-0?o Irl l,�i;•f�± D��_ <br /> Agency Contact: Ck4rfrs Telephone: (Ac*,- 96&--Kyllil <br /> Address: T O . ao,c q,50-101 <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: Ie / 4wor kj � <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: <br /> Date Notified: Time: <br /> D. RESPONSIBLE PERSONBUSINESS <br /> Name of Business �Gf r flus nFdr'1vp,.. orra � /o.J <br /> Contact Person: Not r✓; Telephone: 1 S' �!r7y— yd i7 <br /> Physical Address: E15 ss s, /�.IckrN1� S-I ozkl-vim <br /> E. DESCRIPTION - <br /> Type Release: U� <br /> Volume: -- U( -j<N0ouJ 1 <br /> Chemicals: As mos <br /> F. ACTION TAKEN <br /> 1c __SrT� rs rCAr-rle-4L, UNd,�r C-E H <br /> �+ -fila, c�(►r�r.�,n.N crfi!' f� oro�er�, r�t�.,�,a,� .•• ('ate/h:sy'r��luA•dt��°�-�" 1or�^�fidN, <br /> Dw ,erwtF'J <br /> EH 22 03 (Rev. 7/89) <br />