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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 O p <br /> A. EMERGENCY LEVEL:0 II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: <br /> Reporting Agency <br /> Agency Contact: :TTS!-- T�psc h Telephone: ( 209 ) ,4(cam--'24 2-6 <br /> Address: 11/)Cl f7 <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location (5m M . L#q, , r-, �,` i� / -- c>TZK K'r?) <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: _ 10 1 <br /> Date Notified: _ ,n I�'a lRei Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> -S <br /> Name of Business fJ <br /> . r)sr Cn�-f-1� <br /> Contact Person: RI ( Lzrfe-Q 14 r 1 Telephone: G?X13 ZCr�c`, <br /> Physical Address: )CiCn 0- (-� ( , hict'li w <br /> E. DESCRIPTION <br /> Type Release: 1 'A(rnrr)aiA S-+n re�- 1 ti , k ,, , p isr c. nv r rte{ r♦ nrl �, <br /> Volume: _Unbnou)n <br /> Chemicals: /'flue./ <br /> F. ACTION TAKEN <br /> FuPI wed 6x C"amJ ( 11Tty-io <br /> �4SKS;m0A T I A I i t hP rrr, rr fr rl rtar, I � s HVr ✓v nx fi <br /> ( n��f(),ti�� : , in 7 n S t Prn_t)t r-td �-1. L <br /> 2nnn�� z nJ.e . n� <br /> u � <br /> EH 22 03 (Rev. 7/89) <br /> l'1 .� <br />