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0 SAN JOAQUIN COUNTY 9 <br />NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br />HEALTH & SAFETY CODE 25180.7 <br />A. EMERGENCY LEVEL: a) II III PHS -EH LOG # C? / <br />(Circle One) <br />B. SOURCE OF INFORMATION <br />Original Source: F -ick- A2//c, Telephone: <br />Reporting Agency Name: <br />Agency Contact: v� Telephone: <br />Address: <br />C. LOCATION AND DATE OF DISCHAR E <br />Location: <br />(Best Physical Description) (City or County) <br />Date of Discharge: (ZA1 <br />Date Notified: --7_ / Time: K � O OA <br />D. RESPONSIBLE PERSONBUSINESS <br />Name of Business <br />5 Ay ATO Pira <br />l t,i i,, Cv. N p-rw- io <br />O L <br />Contact Person: <br />o�M� <br />phone: <br />D�5"Ieeph <br />��� <br />lit 3/0 <br />Physical Address: <br />D <br />D, <br />s <br />E. DESCRIPTION <br />Type Release: <br />s Led �fe-Gf <br />S r &vA 45� <br />Volume: ,C" <br />wrJ <br />Chemicals: <br />a l 1-e,,- <br />iF. <br />F.ACTION TAKEN <br />'Tf W K <br />�`i L-� <br />rec t �1 e n) <br />e <br />-�J� <br />�t r+t%e tf- s <br />40- al es s m 0-"-+ roe' l I 1 <br />co <br />I` F:r l -M v A -j <br />K"e!a vl <br />L4 <br />4-tAe <br />P,2 r © P <br />rL tk+e <br />EH 22 013(Rev. 02/90) <br />