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SAN JOFQUIN COUNTY <br />NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br />HEALTH & SAFETY CODE 25180.7 <br />A. EMERGENCY LEVEL: II III HEALTH DISTRICT LOG # P -Oss <br />(Circle One) <br />B. SOURCE OF INFORMATION <br />Original Source: NIC[ HfChCti✓w Telephone: (d0q)`I6?,3z1a.v <br />Reporting Agency Name: SCL✓q �-D CA- c ,� �G ed, <br />Agency Contact: �- -� (�; Telephone: Q62) <br />Address: / iD 0 <br />C. LOCATION AND DATE OF DI <br />C/o <br />Location: / Lea <br />(Best Physical Des -'ption) (City or County) <br />Date of Discharge: 6' / O <br />Date Notified: / Time: /6;Q(�Cyy, <br />D. RESPONSIBLE PERSON/BUSINESS <br />Name of Business c� f7jG�l�l�»,, ry(p e,,,s w�,i�i. _ -7A, <br />Contact Person: G �� Telephone: <br />Physical Address:/ 533 I��S <br />E. DESCRIPTION <br />Type Release: <br />Volume: Grit <br />Chemicals:GP�P� <br />ACTIONF. <br />/I♦/- -_ I) /'yn i / <br />v <br />r <br />