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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 HEALTH DISTRICT LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: Laurie eoi" /1 a- Telephone`: <br /> ,7 <br /> JGlvt 0 O uvw �U G u [vc Cc / i t tr c t <br /> Reporting Agency Name: + a <br /> Agency Contact: LdU VAI C e0 Ili �e. _ Telephone: <br /> Address : 1 & 0 ( E <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: l7J & Ali w, l Laq <br /> (Best Physical Descr�ipt n) ( City or County) <br /> Date of Discharge: // — / Y ' ga/ <br /> Date Notified: �a�� � 88� Time: ap <br /> D. RESPONSIBLE PERSON/BUSINESSS <br /> Name of Business my 0j ; yv <br /> Contact Person: �o k Y\ „„l4 a t*D yV Telephone: <br /> Physical Address : I �cS6, /V , l�► �$ CM+ W� y <br /> E. DESCRIPTION <br /> Type Release: (,GyiQufl+OriZeGQ. re /eas t <br /> Volume: l.(,rl I�Y1O LtJ /!J <br /> Chemicals : Leaded CfQSy �iYt.t.v� tDf�J Petrd /CGfrn <br /> r n� --G�ct�bow.o <br /> F. ACTION TAKEN keCel&ed fC5vI-[3 pT o2 F'" ; ledjrcc,;cL/� v Fes+S or? <br /> (�) lro � �rer Si f'treQc�ired 71 <br /> determine77��he a 4. j � � vf Gwl &—kce)4 <br /> as re uirpct b ?4prop-e; 4te a �eOC, <br />