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SAN JOAQUIN COUNTY <br />NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br />HEALTH & SAFETY CODE 25180.7 <br />A. EMERGENCY LEVEL: �) II III <br />(Circle One) <br />B. SOURCE OF INFORMATION <br />PHS -EH LOG # ?-f� <br />Original Source: -74Zj Telephone: (9/6) 9K,? -.,?110 <br />Reporting Agency Name: 11=1 Zl� 12 , t,, J n U11741 �� ,i of //,FAC9 2LRyicc <br />Agency Contact: C i?cC�LT Telephone: <br />Address: LGn l P WAz e Ly-naI AI/&L �M o CA. ti Z O <br />C. LOCATION AND DATE OF DISCHARGE <br />Location: y 4 t/6 Tag s �,N t; A VE / � ck e A <br />(Best Physical Description)II (City or County) <br />Date of Discharge: _ _olveeeyo.u-1z1. <br />Date Notified: O Q4 y S Time: /n " 3 A w� <br />D. RESPONSIBLE PERSONBUSINESS <br />Name of Business n�� �� �� �j 4 ,n= LL <br />Contact Person: Q A2 Q o I LTelephone: o?o 7 25 C n �l <br />Physical Address: L/4q S 4v,6 - <br />E. <br />v,6 -E. DESCRIPTIO <br />Type Release: �'QA4MLIA �! e/; sct, ✓ceEr{ env e� JC, �<„L %0 2; r G <br />Volume: <br />Chemical <br />F. ACTION TAKEN <br />_1 A 0 e <br />EH 22 03 (Rev. 7/89) <br />