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6 0 <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY C p .7 <br /> t ��f <br /> A. EMERGENCY LEVEL: II III PHS-EH LOG # �� D53 <br /> (Circle One) <br /> B. SOURCE OF INFORMATION 3Q� <br /> Original Source: 4114ne,- Telephone: <br /> Reporting Agency Name: 1 iC� {-bac7r� 5��-V 1G 6F .SAN '!;AC C4 <br /> Agency Contact: u. * 141 450,4-1 Telephone: ( ) X262 <br /> Address: {( 0 'o "� U® S l,��C7�r✓ <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: /9/0 F <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: <br /> Date Notified: 3- - d Time: <br /> D. RESPONSIBLE PERSONBUSINESS <br /> Name of Business 5,4NYG1iy6 :� <br /> � pp <br /> Contact Person: l . TA IV& Telephone: Oa-� <br /> Physical Address: -j /� �'Z� �-�a�, -����C�v�✓ G S�� <br /> E. DESCRIPTION <br /> Type Release: litLr!� � 7 — t�-�L //��z����0.� 7e.��" <br /> Volume: �/✓ ^a�✓`► <br /> Chemicals: <br /> F. ACTION TAKEN <br /> t! <br /> EH 22 03 (Rev. 7/89) <br /> '. J <br />