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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL II III PHS-EH LOG # �1/SZ <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: (''kcarie<: 1±Atv Telephone: 22' <br /> Reporting Agency Name: -Sn u Ja17u'w r-L".. P"Ah'r lyr-CIYA Srry";Ps rMvrrV"o?o 1 D, <br /> Agency Contact: Ck4r(0s Telephone: <br /> Address: _ f0 - 2i-ox -'00'7t Cf+ q5 V-101 <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: y555 S le / T4or.k- r v <br /> (Best Physical Descript'on) (City or County) <br /> Date of Discharge: <br /> Date Notified: 3Z&1,hj Time: — <br /> D. RESPONSIBLE PERSONBUSINESS <br /> Name of Business C'G f r lks Dellelc1Jyy p"4 <br /> Contact Person: _�i c N�fi N: Telephone: 1S' 17,74/- 116j7 <br /> Physical Address: ss mr-kit'AP4 S-�ockt-ti� <br /> E. DESCRIPTION <br /> Type Release: UA r2 <br /> Volume: __ UNKN0w)J <br /> Chemicals: _—.A-- <br /> F. ACTION TAKEN <br /> "/L,i� SrT� i; Cum �, UNC�I�r �c tN�f ssP>5N1c' a C= i'( <br /> _elf <br /> _� 011 -?�'C!' G�v�-/ Ct QeJ3 hauQ l��P••, n�crir/��,Pc.� o� ��i.S SI/! <br /> r <br /> ���'�.�:MPN7t' �, ►•� Nc��i,�; h� (���rl'Icts Ow• Pic'Atrr.,� /o^ta�'�lol�! <br /> EH 22 03 (Rev. 7/89) <br />