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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 # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: GIG ,. �,i-t I �tD'� Telephone: <br /> Reporting Agency Name: U- to C pk ac- <br /> Agency Contact: �I§bj& kDcTelephone: <br /> Address: 4 0. u <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: - � ll �i. Pic �r,� L— <br /> / <br /> (Best Physical Description) (City or County).. <br /> Date of Discharge: <br /> Date Notified: 2- i 4 - Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business few pim/P A ., ---- <br /> Contact Person: ALLO 1o1bT-{2— 13jlt Z Telephone: (Ltq } <br /> Physical Address: Fac- <br /> E. DESCRIPTION <br /> Type Release: --I A"0�4,S <br /> Volume: <br /> Chemicals: -- �LC)Lt P G <br /> F. : ACTION TAKEN l (7 <br /> I 1 �, Yk 1 r <br /> t 6'Q�Z I t} LL <br /> - <br /> s sS wkr u n7E-U <br /> -*1 ))R� if <br /> EH 22 013 (Rev. 02/90) <br /> F <br />