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vp <br /> SAN JOAQUI N COUNTY •�- J V <br /> NOTIFICATION OP HAZARDOUS WA-STT DISCHARCP <br /> HE'ALTU I. SAM-:TY COW` L;lUU . 7 v <br /> rl <br /> A. EMERGENCY LEVEL: t T ) II lII HEALTH u1STRICT LOC 11 <br /> ( Circle Unc ) <br /> B. SOURCE OF INFORMA`1'ION <br /> Original Source : <- :1 . Telephone : <br /> Reporting Agency Name : <br /> Agency Contact: ( ,-�,., , , r,Ic �.�/. `Telephone : <br /> Addx'ess : <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 6, - - ---- -"'' — <br /> (oustvIIYSICal l:iLj' <br /> Cr `, <br /> Date of Discharge : �(•% <br /> ? J <br /> j Date Notified: //l;�R c) `1'iwe: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business _ ciI <br /> Contact Person: ! r� T ! )Ltnnn_ '11elcphone: <br /> U <br /> Physical Address : l� <br /> E. DESCRIPTION <br /> Type Release : V,,t(t4,i <br /> Volume: 1� <br /> Chemicals : <br /> F. ACTION TAKL'tJ /-'t z C!s u^_ �•l�j�'��'% , �Urit��- -'�f- °Ct' L!c•�-��C . <br /> ,/�•�f. /Z-l�(Clui 'ff- ,.�0//�} irk.-�( ��TC t' /1';.y�C��?--.'`- lti.��� ..13•C�'��='� ci,� �'i"h./;�:r�—��n.:_.c.r� �/ <br /> //) � •� .� c,�C'[ L-t' ��-tel cr%:.. �`..(���f / <br />