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SAN JOAQ U IN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> r '� <br /> A. EMERGENCY LEVEL4 II III PHS-EH LOG # QQJ <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: 4,t r n-k -rn C• Telephone: (,Y/15 12-15- 99'7 <br /> Reporting Agency Name: q <br /> Agency Contact: L,g-1(7-h`e1 �, SC�� Telephone: -416 L-3 Z/3 l <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location:. � � �1, div i`�� �_ / cS to G A XYU <br /> (Best Physical Description) (City or ount <br /> Date of Discharge: <br /> Date Notified: 9j l/ Time: q 0 QO&�J <br /> D. RESPONSIBLE P RSON/BUSINESS <br /> Name of Business <br /> Contact Person: �)&1 ybvcilj Telephone: (,- 6 Q-fv/��• <br /> 7 1'Yilc .�orc�, ci533 <br /> Physical Address: �6 -� � �� -�-� - , r <br /> E. DESCRIPTION <br /> Type Release: /1- ;�i ��/ �`�D 0� i � 116sr <br /> Volume: <br /> Chemicals: <br /> F. A(�I'Ia <br /> Gly G S 7`. <br /> CiVU G r /7� >�U! <br /> EH 22 013(&v. 02/90) <br />