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SAN JOAQUIN COUNTY a <br /> NOTIFIC)6ION OF HAZARDOUS WASTE 1~�ISCHARGE — <br /> HEALTH & SAFETY CODE 25180.7 <br /> A . <br /> EMERGENCY LEVEL. � II III PHS-EH LOG # <br /> ircle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: I-Ivpnr t --x Telephone: <br /> Reporting Agency Name: 2019I1c. Wen t4-h Ser-yiCbS <br /> Agency Contact: ( . mot Telephone: <br /> Address: 4,4t:i Q . <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: p 6. 1=lcx•, -Pfi / U r�der� <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: L) <br /> Date Notified: q 17,-� (q0 Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business "ypn*IeX <br /> Contact Person: Telephone: (.?�4) 2n -I- <br /> Physical Address a3�g� �. -Inr� { �er�cl �, cl <br /> E. DESCRIPTION <br /> Type Release: 0" Clt���rnono rIAA � r n ( I fin M!' r^ vrirn/r� <br /> Volume: r Snk-OL n <br /> Chemicals: <br /> F. ACTION TAKEN <br /> Yr LC±b z, Qc c,e "rrtiorr- W o l lne -{D 6 <br /> ffV rV3-t2 Lr e d Pnc fir�nt C n r�fiYt Y�ILYLEI�1_Cl rB'j Ul r��f (�cT <br /> EH 22 013 (Rev. 02/90) <br />