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SAN JOAQUIN COUNTY – 4,�', <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL II III PHS-EH LOG # � a �3 <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: ('�r,r{oc {�r, f Telephone: <br /> p ( �r - <br /> Reporting Agency Name: L.i 61 /-Arlol <br /> Agency Contact: C L nr(r,5 Telephone: <br /> Address: —Fd• Scs 9oog 54,rk4n <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: L S, /�ppp7F / cIm kfru t <br /> (Best Physical Des ription) (City or County) <br /> Date of Discharge: (ALvk&Mtj <br /> Date Notified: LD19 9 Time: ` !2s–PM <br /> D. RESPONSIBLE PERSONBUSINESS <br /> Name of Business &iAt) &kers. <br /> Contact Person: john. kook Telephone: (ZV2 ) 9Y� -0912 <br /> Physical Address: _9 brl S. Airport (alg�, Sfock4yN ��3 <br /> E. DESCRIPTION <br /> Type Release: _ i% <br /> Volume: iv owns <br /> Chemicals: /)r+oleww <br /> F. ACTION TAKEN <br /> /0 ,1k I�PYN 1f�� <71 r,�� Ik rPurcrl�af soi/ <'GtA /nry,,ura{i�9r <br /> U/'7�Ph 51GssFrlriw 0 N he rP<sUiT��i/ �y' c�Pr�/Nm 1iP <br /> 1ycrfure o: r./ P ati of co�,1r�.,, Fi' o� rfn . AOIJ 6v -the <br /> L r is to t-ex+;, <br /> EH 22 03 (Rev. 7/89) <br /> i , � <br />