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lzR <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF IHAZARDOUS WASTE' DIDISCHARGE �\ <br /> HEALTH S SAI•'1•:TY CODE 251130 . 7 G <br /> \\D <br /> A. EMERGENCY LEVEL: II III HEALTH DISTRICT LUG d � <br /> (Circle one) <br /> B. SOURCE OF INFORMATION <br /> Original Source: �1l'rliszykTelephone: (7 ) C+- �4. , <br /> Reporting Agency Name: /tn ir,i1/ : r: , 1 M, 'r, <br /> Agency Contact: Il.l r",a• I i�r : I , r: _ 'Telephone: (%w,) y_.A-:34A. 7y <br /> Add.ress: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: _l �f l i?n <br /> (Best Physical Description) (City -or County) <br /> Date of Discharge: <br /> Date Notified: <br /> Time: /C)0,1, <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name -of Businessi'/ f7/S <br /> Contact Person: % i%.c Y. -��; �l LI Telephone: (=:�) 4)V/,. <br /> Physical Address : <br /> / `i°-�-EW <br /> E. DESCRIPTION <br /> Type Release: _ (,{,i?L).iw��7, // Z i� r a�� : i ,: / i} r rig fir21ji/G,, 1. <br /> Volume: <br /> Chemicals : <br /> F. ACTION TAKEN <br /> t <br /> •-�/l. ���;;j �'i.C° /1 ;%,,11,71„cj+F+. aT 4120 , <br /> Ld Y A J ”\-�YJ r� -r.'i ��C/ d,Y--.�. .� 4✓ IJ"// (l/" r i i r r <br /> r T <br />