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SAN JOAQUIN COUNTY <br />NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br />HEALTH & SAFETY CODE 25180.7 <br />0 <br />A. EMERGENCY LEVEL: II III PHS -EH LOG # i r J.P <br />(Circle One) <br />B. SOURCE OF INFORMATION <br />Original Source: p . N'i Telephone: (� ) g 3� f O <br />HCU.v Z05'00 POLL-/ DZIYEi <br />Reporting Agent Name: <br />Agency Contact: Telephone: <br />Address: <br />C. LOCATION AND DATE OF DISCHARGE <br />Location: 20500 Nn j � '[*�E2 �y C / <br />(Best Physical Description) ity or County) <br />Date of Discharge: I <br />10 <br />E. <br />Date Notified: 9- -4 I Time: <br />Cl ° � a.y►r1 <br />RESPONSIBLE PERSON/BUSINESS <br />Name of Business H C»`y x �eltz- <br />Contact Person: ��� u _KS Telephone: (2O ��512 <br />S-2 <br />�v <br />`� nC� `� t �` `i T'Z'� Com/ <br />Physical Address: <br />DESCRIPTION <br />Type Release: <br />Volume: _0 <br />Chemicals: <br />F. ACTION TAKEN <br />EH 22 013 (Rev. 02/90) <br />