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0 <br /> "AN JOAQUI N COUNTY <br /> NOTIFICATION OF IIAG/1RDOUS WASTE DISCHARGE <br /> 111'ALTI I & SAl'1:'.I'Y COD1: 11--Jl i U . 7 <br /> t�.:./ <br /> I ) II III HEALTH DISTRICT LUG <br /> A. EMERGENCY LEVEL: (� `� '� <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source• J Telephone: =- <br /> Reporting Agency Name: <br /> Agency Contact: ,,� r; kt_ _ `1'elephonc . <br /> Addvess. �c'� lid—y 0j <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 6,3 ) v✓ <br /> (li�.S i.. 1'lty51C`ctl UC:�i.:l'11)�1ull) l l.t l j' vi L:.:ui:l.}, j. <br /> C` <br /> Date of Discharge: <br /> _ Date Notified: 111A CI `1'irae: A <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> * r <br /> Name of. Business U S �• < - u !. <br /> Contact Person• 11 Lc.w� .Telephone: (, :?`t ) 4 4 0 '0-1 <br /> Physical Address : <br /> E. DESCRIPTION <br /> Type Release• X11. ���i1i��.��` .�- ���111/ <br /> Volume: <br /> Chemicals : <br /> F. ACTION TAKEN 7 C,6- <br /> �a <br /> ✓-v. A„elt[ l +'l C;+ ldL�-�`.kN'ti( Lice` �N`l�^��` / •t l(.^a��i L''''="' L'!, L_.I�'�'r-! ti%J^.-.L2-k,1..C.j�. /.�/ <br />