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ti �t <br /> SAN JOAQUIN COUNTY `� <br /> NOTIFICATION OF HAZARDOUS WASTE.DIS 12 <br /> ) P�f <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:(J II lII PHS-EH LOG # `7 7 3 <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: (� DQE ( Telephone: 0q- O O <br /> Reporting Agency Name: <br /> Agency Contact: Telephone: (_) <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: a�-�`�- 1� • r10 (1r1X� / _ -�r�li1 �� <br /> (Best Physical Description) i r County) <br /> Date of Discharge: 'j <br /> Date Notified: Time: . <br /> D. RESPONSIBLE PERSONBUSINESS <br /> Name of Business <br /> Contact Person: _1 GZCki, y Telephone: ( L}II�"} � <br /> Physical Address: V.o mow CO g(4 -S7 ----3'7 <br /> E. DESCRIPTION <br /> Type Release: _._ _ 011a LIC4 (.pa LS- <br /> Volume: <br /> Chemicals: ___V Ili Sc, <br /> F. ACTION TAKEN <br /> ups JA �/,-KPA A v <br /> J ` 5,A ��� 4 uyYL t1tp��i711r� <br /> `a-o_ Q � t�l� ,ire �,�.-�Vv► ��.—f i I"y� <br /> c <br /> EH 22 03 (Rev. 7/89) <br />