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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE,DISCI-IAJ. GE <br /> HEALTH & SAFETY C �180.7 _ <br /> A. EMERGENCY LEVELO II III PHS-EH LOG # 90— �3 <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: D P Telephone: (Y/D yew— 9 7-51 <br /> Reporting Agency Name: �An/To����� r;J (>, '�� ►, ;� I-�r=��, TM S�iZV iC r S <br /> Agency Contact: o &-� N ,4 Telephone: (2-0 <br /> Address: —P, o , 66 X 2 o o G 57i�G 7'on/, X19 IS Zo/ <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: ;D 3 5D �' �,��,� ��vo <br /> (Best Physical Description) (City or ounty) <br /> Date of Discharge: o�.✓,� Q <br /> Date Notified: 2 —S'-9 O Time: •��� ��''> <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business ��G �✓e S�i�}� <br /> Coptact Person; iP.9/� ST�TG.�Y Telephone: <br /> Physical Address: - 3 D 3-SD 7L5- <br /> E. DESCRIPTION <br /> Type Release: y .� <br /> Volume: r <br /> Chemicals: cA,e o/VS <br /> F. ACTION TAKEN <br /> y2o nr�¢„ 1 ;„, Ta / rte <br /> -ur►c�e�^�rr>u��/ Ski v�>�rP 7 i ivy" f^c��rayP� 1J Al Z-11- c/O. <br /> ,�- <br /> -a�e 7e, �i✓7�9/�'/iit/�47/a,i <br /> EH 22 03 (Rev. 7/89) <br />