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SAN JOAQUIN COUNTY {� <br /> NOTIFIC�AON OF HAZARDOUS WASTL.ISCI-IARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL 11 III PHS-EH LOG # Z Q �O <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: _ r�rirl� {�u. Telephone: (��_y6S�- ?3WO <br /> Reporting Agency Name: 2N Pude. llrOHl 5elnrcP s <br /> Agency Contact: ['`yarlos Telephone: (� )_, 6:f- WZ� 2 <br /> Address: --P0- .66x -2OOl qOcAlew 64 9f-;�[>7 , <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: lqc5- S, Ft,,rao / SAO, k40 P-) CLQ <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: <br /> Date Notified: /go Time: 10:yS- ffM <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business Kk,:L, Rn tir,^s <br /> Contact Person: R1r(iarrh klpt /�_ Telephone: (.20? <br /> Physical Address: "u�� tea ' tifa,/iNcs Wren, rs • F2,Bey 6*M 5'7(c4fcw r,4 <br /> E. DESCRIPTION <br /> Type Release: p" due �b n70 nheW2?1aAr/ 42i2:Z //A/,- <br /> Volume: veVolume: Uti�N � <br /> Chemicals: <br /> F. ACTION TAKEN D <br /> ♦Ur;`7.er �rt a�<-o- tv�,� � �,,./I mr��. �fl' � r��i'1n�N2 �+� <br /> r� �� f'Pr��/ri1�o/4t/ griPvriPr' <br /> EI-I 22 013 (Rev. 02/90) - <br />