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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG # <br /> ( ircle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: (ub Telephone: (_?12f) z&�(o -�f p <br /> Reporting Agency Name: 7-220x_ 40z,124 � ✓ 'v� <br /> Agency Contact: 4cp„ �[� Telephone: <br /> Address: IVr A/ S2 n <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: �si)n 1_47. Pa on-t- 4 P_(tib / Sita r <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: Un 1� 1� <br /> Date Notified: Time: tz4a,*� <br /> D. RESPONSIBLE PERSON/BUSINESSES <br /> Name of Businesses <br /> Contact Person: �;�� l 75�y�¢� �� Telephone: <br /> Physical Address: ?inn L) 0 /010 `R/v c( . S�k-'j <br /> E. DESCRIPTION <br /> Type Release: _, ee 0 Ao.0oa nv 06i7 �f <br /> Volume: <br /> Chemicals: b F�J C4,I' 9`- r 0 1 RTX4E� <br /> F. ACTION TAKEN / <br /> a 12'l/J,12-1,4 ! -zj Z�'.Ali ?��/YYII fAw7]�J <br /> EH 22 013 (Rev. 02/90) <br />