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A. <br />10 <br />A <br />E. <br />0 SAN JOAQ UIN COUNTY • <br />NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br />HEALTH & SAFETY CODE 25180.7 <br />EMERGENCY LEVEL:PI)rcle <br />II III PHS -EH LOG # <br />One) <br />SOURCE OF INFORMATION <br />Original Source: jq e0o Telephone:�}( IS) 5� 1-Zy R Z <br />Reporting Agency ame: <br />Agency Contact: <br />Address: 4�— k( <br />pwor <br />.._k.'i➢iWY1�ir,YIf2141 dli2a '11�Y1Y�' <br />Date of Discharge: <br />(City or County) <br />Date Notified: 1I2?3 01 Time: C10oe'lv'` <br />RESPONSIBLE PERSON/BUSINESS <br />Name of Business P20 Li-tS 00m�X'v�tL' <br />Contact Person: J, n6) Telephone: 4( <br />Physical Address: <br />DESCRIPTION <br />Type Release: <br />Volume: -- <br />Chemicals: <br />F. ACTION TAKEN <br />�f I Z S rt"C C3,�� i� (A �i t in rck. ` < E� tart t,�_��Y <br />EH 22 013 (Rev. 02/90) <br />