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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 PHS-EH LOG # <br /> j <br /> Aircle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: tr) k,1,r„CTn���jj Telephone: ? ) 4&y„ - � 3 <br /> Reporting Agency Name: Z2120r- 164J4 3Lk/i(Ia1, <br /> Agency Contact: ��cpjp<, Telephone: ( 7c/6�__3�?� <br /> Address: y�f n/ Si , l�rar„ Sf Sfack ,� <br /> 19 <br /> C. LOCATION AND DATE OF DISCHARGE S' Y � <br /> Location: -si)D /A2 (7nr)O >"4 o (db / <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: Un 1� �-o)-� <br /> Date Notified: /p/i 1010 Time: `f � 51 <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business 4C cAOh, #-r� 4 0111L <br /> Contact Person: R;// J nyr)fa,lM_) Telephone: ( ?off) —`746(D -y313 <br /> Physical Address: <br /> E. DESCRIPTION <br /> Type Release: 21LIZ A.'e, i>/y ,,14 P/i 0 Ill'-T f <br /> Volume: <br /> Chemicals: A'j 4,i0,� r ram r/.,- o, 1 7X4F) <br /> F. ACTION TAKEN / <br /> -H,/�,t�i J �.!�1 /k .O.�QILQ l�Oir� ,/.(r-C�,� ,(i-Q /S Ola �iii o .oI✓ . <br /> a-,K 111 u-z- <br /> EH 22 013 (Rev. 02/90) <br />