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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEA�.TH & SAFETY CODE 25180.7 ; f <br /> t� <br /> A, EMERGENCY LEVEL: 0 II III HEALTH DISTRICT LOG # — <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original ..Source: Kw PAL- SIP2J''a Telephone: <br /> Reporting Agency Name: a d lic. <br /> Agency Contact: J � <br /> Telephone: ( ) !rt" " -3 p <br /> Address= �� a i9d d '7C?t� Jr✓ 6A-( <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: _/L,// J, �1 SY- / ��7UAl <br /> ;' (Best Physical Description) (City or C nty) <br /> Date of Discharge: _ow?tez 0.-V/v <br /> Date Notified: Time: ?,wa '✓ '-1 <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business AlGJ �(� <br /> contact Person: Te y /4.$' Telephone: <br /> Physical Address: _j` Z,;/v S%, , UZ <br /> E. DESCRIPTION <br /> Type Release: p/�he, Zewt <br /> .Volume: /,c::f <br /> Chemicals: <br /> F. ACTION TAKENe OJL 7LAN�' / 'L�/!e• Gi CiS ��it ,c��. <br /> 'Li,�- ie.� Si e aSSe SS!'�'J � 44-';// be 1!lee1 14 rlZe-11" 4-V <br /> A4• -&3deo F Com, U HvAia <br /> 09 Y. /'am u 144V y _" <br />