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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180 .7 <br /> A. EMERGENCY LEVEL: II III HEALTH DISTRICT LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: lArApt4 F Dhk DO-A--OP-y Telephone: ( 20111 8'5- 13vo <br /> Reporting Agency 1Name: Gd_�)A QLA lid Oe-A Hf--AUT"AUT D I S7/Z1 Sr <br /> Agency Contact: W, LL Ann fL . S &JetyTelephone: Q0j) <br /> Address: 1 0 C��o AJ <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: &/ �. Gf� �7�2 �V / J7� y`"� 95�� <br /> (Best Physical Description (City or County) <br /> Date of Discharge: y/✓K <br /> Date Notified: lam" /p — S r Time: J •'���"` <br /> D. RESPONSIBLE PERSON//B►U�SINESS <br /> Name of Business <br /> Contact Person: z/}R2Y P�S Telephone: <br /> Physical Address: //DO A5 CW,4Z71�� �/Q'i ,57aGf�a.✓, 9�Z66 <br /> E. DESCRIPTION `� <br /> Type Release: ��A1A6/1hoe1kEP rMW5e- <br /> Volume: 11A;e00?0(n/1 / <br /> Chemicals: /T/4G LPt G/ <br /> F. ACTION TAKEN <br /> �u� F� S ife Gess//esssyr�� W, LG be r u•^�e4 Z-p <br /> oPo�"y-dJii�7�i ate /nGPTL�/'L G! `r R� eX fe�`-� O� c.e N7A Nr i:vA'r�iTr <br />