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1 <br /> (11 <br /> 01, <br /> SAN JOAQUIN C UNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE ' <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: II III PHS-EH LOG # <br /> Circle One <br /> B. SOURCE OF INFORMATION <br /> Original Source: ., 2/r /- <br /> Reporting Agency Name: �� -� �+�� x, ,� �1f5 -�' 7� <br /> Agency Contact: T lephone: (? ) -'1E�,r-3`QST <br /> Address: ,/6 <br /> ('s Saa <br /> C. LOCATION AND DATE OF�-e"• DISCHARGE <br /> Location: '.Kr*1 A //0,j7 ytro,1 K <br /> (Best Physical Description)' City or County) <br /> Date of Discharge: <br /> Date Notified: /_ - ,�- Time: ��' C�C� <br /> D. RESPONSIBLE PERSONBUSINESS <br /> Name of Business 5�'� a rc�) Ce 124 <br /> Contact Person: <br /> Telephone: <br /> 7331C�`1a <br /> Physical Address: /-30 0 <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: ' <br /> Chemicals: <br /> .F. ACTION TAKEN `1 <br /> 'r `=flhCL.-i'L,`%-,'.' `:�:� C"'. ,',� C7 -�; �?'fr f�ll' t •� Cy �lUr?Gl�G7Cs'; ',, <br /> xr <br /> El-I 22 03 (Rev. 7/84) <br />