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Iry <br />SAN JOAQUIN COUNTY <br />NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br />HEALTH & SAFETY CODE 25180.7 <br />A. EMERGENCY LEVEL: 'CP II III HEALTH DISTRICT LOG #�,®O <br />(Circle One) - f <br />B. SOURCE OF INFORMATION <br />Original Source: �-vkc F',,.•dt4.� Telephone: (4((p ) 366-1401 <br />Reporting Agency Name:�Soaq,:.� <br />Agency Contact: oav d Ga,�ls Telephone: (2�1) K&J-;qyo <br />Address: 1001 �. liaae(kN P.®. `fox 200g SA -3,-6.,,, cq nSzor <br />C. LOCATION AND DATE OF DISCHARGE <br />Location: tS` Gv. (Ov.. I -,,,c k /-j-,,�cy <br />(Best Physical Description) (City or County) <br />Date of Discharge: v�..�.wo...., <br />Date Notified: 3 (9 rrr Time: <br />D. RESPONSIBLE PERSON/BUSINESS <br />L* <br />Name of Business Foal 4 L, V®,r <br />Contact Person: Telephone: (-+-f) <br />Physical Address: is- <br />DESCRIPTION <br />sDESCRIPTION <br />Type Release: jzk1a y1 -k,0 -.e zed gel ea -se- <br />Volume: <br />Chemicals: {P�a� pniro�e.,�. t��d,.® Ga✓� ►-�l.,e�t� k.�\c,.� 1 L..,�e.,Q <br />F. ACTION TAKEN <br />1 1 �.o h�Cn .+w.�.. 4�• ON <br />4- <br />h <br />,.r'tt.e. <br />S;{c assess ��. S�-4c •.ssess•..c�t -%� <br />