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SAN JOAQUIN COUNTY <br /> NOTIFl�-"TION OF IIAIARDOUS WASTE DISCHARGE <br /> lIEA.LTI I & SAFETY CODE 25i&0 <br /> A. EMERGENCY LEVEL: II III PHS-EII LOG ,# <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: e,-4- (QnL 1` Telephone: 12 9 SO <br /> Reporting Agency Name: �; ` P �S — �5-0 0 <br /> Agency Contact: � F i ,� Telephone: (____ <br /> P z�) 16 y-� %sY <br /> Address: <br /> C. LOCATION AND OF DISCHARGE <br /> 14, 0?.35 - /S- az <br /> Location: 1- OCA �InC k � v A I., / <br /> (Best Physical Desc iption) (City or County) <br /> Date of Discharge: y/J�/!o�/r� <br /> Date Notified: Time: <br /> D. RESPONSIBLY PERSON/BUSINESS <br /> Name of Business CQ- L <br /> Contact Person: C- sem„ <br /> s Telephone: <br /> Physical Address: 0 K y �. <br /> E. DESCRIP'T'ION _ <br /> Type Release: % err v.1a/c,ly r �.� nI e u✓1 re v,'� n <br /> Volume: <br /> Chemicals: Irb leu,,', �jr�taC4r�Gr�S <br /> F. ACTION TAKEN <br /> tj C' cl UCA-A <br /> A0 ►k,qe <br /> I <br /> ` S l Ct <br /> Lve— <br /> cy� �✓ <br /> c <br /> 131-122 013 (Rev. 02/90) <br /> y <br />