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%' N JOAQUIN COUNTY ft <br />NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br />HEALTH & SAFETY CODE 25180.7 <br />A. EMERGENCY LEVE I II III PHS -EH LOG # <br />(Circle One) <br />B. SOURCE OF INFORMATION <br />Original Source: P(►-k�j Sri„ {L Telephone: ^o <br />Reporting Agency Name: 2- <br />Agency Contact: Telephone: <br />Address: P.O. f3dx 2-022 <br />C. LOCATION AND DATE OF DISCHARGE <br />:... Location: <br />(Best Physical Description) (Ci or County) <br />Date of Discharge: Uti k Nom• <br />Date Notified: Time: <br />D. RESPONSIBLE PERSON/BUSINESS <br />Name of Business <br />Contact Person: r;r,,i A„kJer—,t�j TeIep��ho//ne: <br />,'Physical Address: `f'il S, Zias�r�ar� U✓/�r <br />E. DESCRIPTION <br />Type Release: U A 2— <br />Volume: Volume: UN k <br />Chemicals: I)Pfre)tetkyn t1 mrrxrfX7►.�c <br />F. ADCTION TAKEN n <br />itE'sK�p `' Ecr1 /�, �rso�+ Cis f..ro^rnf� 4ed I'i=s',w, n� (lbS a,� T/sP�ptiyfro,✓rnA- \ <br />re;F 4'pr Srfo c�';q 6e- h°"iU( 41 Q�P7�Pnla�YNP 7NP_ N <br />_. 0"d 00elllf off' er"114641W04r�& is /-y°-, a1/'F lz. 7`iP r d f>�e�1rYu <br />CI G4pn,r1IDS <br />EH 22 03 (Rev. 7/89) <br />