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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE �� <br /> HEALTH & SAFETY CODE 25180.7 CA <br /> A. EMERGENCY LEVEL: / I ) II III HEALTH DISTRICT LOG <br /> (Circle One) EI <br /> B. SOURCE OF INFO TION <br /> Original Source: 11WC, , �fl�j( _ Telephone: <br /> Reporting Agency Name: ?)/)1 o Locki.. ffr,,�7l "mSi— <br /> Agency Contact: ).i51`w Telephone: (N) f <br /> Address: 27� r r � � ��tJ <br /> �U <br /> 9� <br /> C. LOCATION AND DATE ,/fOF DISCHARGE <br /> Location: _.5�bCJ f � u F, (' ALWI <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: U Uy- )0U00 <br /> Date Notified: oMiL� -z �9� �C Time: <br /> D. RESPONSIBLE PERSON/Bi�U^S'I,N�ESS 1 ` <br /> Name of Business /11dY <br /> Contact Person: N({�IL '1'•\\S - G1LYff-; 1N Telephone: <br /> Physical Address: (� Ulf �,ti ��_� = 13molit A (!1 <br /> E. DESCRIPTION W01�T <br /> Type Relealsle: (1�1fl1L111b�211 Llt� � �Q('V{l � �IJ�Fk�-Pj1111JD � 3(LMoC R{ Af_ <br /> Volume: UW-kew� <br /> Chemicals : 7rri� L� &-% k-TCO(aA11L 1�(Fl(ALi�s8.J5 <br /> F. ACTION TAKEN <br /> �f(<�:,Gf-t fhb �"cl�ULr�� lkZe-Furlr <br /> N�I Fi�t7i Zn-� l S i I- Vu ISE, y TIftS Cl nit 'Tb (G TD <br />