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49 <br />C 0 Fl0- <br />M SAN JOAQUIN COUNTY <br />u NOTIFICATION OF I-(AZARDOUS WASTE DISCI -TARGE <br />HEALTH & SAFETY CODE 25180.7 <br />A. EMERGENCY LEVELOII Ill PHS -EH LOG # <br />(Circle One) <br />B. SOURCE OF INFORMATION <br />Original Source: —L44 •,I- Al Telephone: Lo <br />Reporting Agency Name: J o t - , ? ft) A),30- <br />Agency <br />30Agency Contact: J _ / Telephone: <br />Address: <br />C. LOCATION AND DATE OF DISCHARGE <br />,SJT744r 7./ FUFL ra"')y ANo <br />Location: Sroxn�c THUK 1533.E Burs y/ .�T.�-vr�N <br />(Best Physical Description) (City or County) <br />Date of Discharge: /(3 - / % - S,�-? <br />Date Notified: — /Q - ��� _ ��a Time: l U,5 P/�) <br />D. RESPONSIBLE PERSON/BUSINESS <br />Name of Business S''7-,-)C/iT7A/ /r/MTRJ�y� iL HULL 01„ LICT <br />Contact Person: ,L� <br />--�---_Y � � ��Li �?.�v Telephone: y-i',s -5.5G G <br />Physical Address: /533 J JT <br />E. DESCRIPTION <br />Type Release: <br />Volume:' <br />Chemicals: <br />F. ACTION TAKEN <br />EI -1 22 03 (Rev. 7/89) <br />