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SAN 7OAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARCCO Q <br /> HEALTH & SAFETY CODE 25180.7 <br /> A EMERGENCY LEVEL: I II III PHS-EH LOG # l6 <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: Telephone: Ctkn Y"641 YG� <br /> Reporting Agency Name: c5w,? �,'., p„yam *k, :;,,w _Se- SPS <br /> Agency Contact: �u�o/ p z_ Telephone: off- Y(0 1p-�'V6 � <br /> Address: 66?1 f_ ! e// xe. Z4Xe fes, 9s.�/ <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location _�gy f L n lecCe C� <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: <br /> Date Notified: -d6 - pv Time: .ver <br /> D. RESPONSIBLE PERSONBUSINESS <br /> Name of Business ! ScLicx�//� sfri�f <br /> Contact Person: 1/liinPS 7� Telephone: O 3 <br /> Physical Address: 9 9oi f. L ,s �yy,P• � �� <br /> E. DESCRIPTION <br /> Type Release: Ax <br /> Volume: <br /> Chemicals: <br /> F. ACTION TAKEN <br /> s f // c e s <br /> EH 22 03 (Rev. 7/89) <br />