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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 PHS-Ell LOG # 0 01 (1 <br /> (Circle One) <br /> B . SOURCE OF INFORMATION <br /> Original Source: 6wQs 1 .�.tjlrJLWkk' Telephone : <br /> ( A <br /> Reporting Agency Name: `J/ Tyr-)QLM11 �' P0Lw <br /> Agency Contact: G1lytjl�S Telephone : ( 1451 ) CA344 � <br /> Address: kDo l GO AQk 6rV -t-� C✓� <br /> Co LOCATION AND DATE OF DISCHARGE <br /> Location: ClirL� Wit <br /> (Best Physical Description) (City or County) <br /> E <br /> Date of Discharge: U1LDwt.3 <br /> I <br /> ( Date Notified: Ll f'Lej � zj p Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business Lx)( AaJ <br /> Contact Person: _rt)4 'L L1 �6TyrJ Telephone : ( L�J �j ) � .3 LO 1- 11 <br /> Physical Address: ` o (LL Uxr-ktNo LurZksJ cep cl _ i ) o l <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: lwy K-NocJt4 <br /> Chemicals: )(qui " 1 bL' LA' iNij - <br /> F. ACTION TAKEN <br /> L✓� �o ✓C/1 �D�wl /c_c; Su-�,� �St, �� F-c r nz - r\ trr nJv /l'r- trf-t rnr itr� yl <br /> Sr TI her-� rcr�nrj LryNGr /Znr G/LFJI� uut� L✓ rrTL�L CIrJ)3�7rr✓� /JizJ � � <br /> �.rir2ilJc�r � /N ✓GSr7ei,971d�� c✓d /UL /Yiv>, vrrZ ,���ae >> r �tnaJ l.� r �l... <br /> /I�sZ.irui� r � r-tr 7aJ15 Sr rL.,r' <br /> EH 22 03 (Rev. 7/89) <br /> 121�1�'L�r2 � fel ` 1�"�'l,<<4'LRmrIL+� �� c? <— Jl, � ✓; C_ �� . <br />