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K <br /> SAN JOAQUIN COUNTY <br /> l NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH 6 SAFIi'1'Y CODE 25180 .7 <br /> A. EMERGENCY LEVEL: II III IIRALT11 DISTRICT LOC M O l -01�0 <br /> (Circle One ) <br /> • B. SOURCE OF INFORMATIO14 <br /> Original Source: C�)r ✓(�ga -ho-)''J- Telephone: <br /> Reporting Agency Name: /�^ GGiJ ✓) �DlQ� //f l//�flr � <br /> Agency Contact: [wr�r. ��a �L _ Telephone : ( ?�) <br /> Address: /601 NAZ-f <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: la3Sr E '41011 l / -6 <br /> (Best Physic/al/ D�e/scription) (City or County ) <br /> Date of Discharge: 12h1 <br /> r Date Notified: 31j�1��/ Time: . 10=dd� <br /> l D. ' RESPONSIBLE PERSON/BUSINESS 9 ) <br /> Name of Business/� i� iCYlihUi��o� ✓ <br /> Contact Person: n u(�k t1-P-7,yA10., Telephone: (am) <br /> Physical Address: <br /> E. DESCRIPTION G 9oev <br /> Type Release: <br /> Volume: 6r1x & a-.,cn. <br /> Chemicals: _ /, - <br /> F. ACTION TAKEN <br /> U <br />