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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> � U u <br /> A. EMERGENCY LEVEL. II III PHS-EH LOG # C?C) a �� <br /> ircle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: Pl4G fIE�- 1p Telephone: ( 2�Cq) 41(g'�'-3S�9Z <br /> Reporting Agency Name: pub lic Ijea (4-h ,fir ces -Enyi y-nnrrY--crht ( NPS I J-h <br /> Agency Contact: K1S2cj Telephone: (-2a) 4(gR'-3q(o� <br /> Address: r r✓� S t S l <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 3�I 1 � Guig R iyc(/ �� f <br /> (Best Physical Desc iption) (City or County) <br /> Date of Discharge: o o Lrouj n <br /> Date Notified: q j/!� qp Time: s3soz yu <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business `RnQ( /H,2 1' 1:IY 7)M(Ttlye 2 rV r Ce <br /> Contact Person: jrl %Z 170,rkP r Telephone: O 'd-l(" <br /> Physical Address: 2-1,51 � LMLL i 0-(U t�, 9/U(11�t4&1 <br /> E. DESCRIPTION <br /> Type Release: l f)/15L <br /> Volume: ()h kno,i l✓) <br /> Chemicals: (/10'SrO O i l <br /> F. ACTION TAKEN <br /> 4�✓Z rpt to <br /> //.//(o(i( �7i/ 7�t0 /d��� (J 2xze�& /)QCrtzG+ 'L� <br /> EH 22 013 (Rev. 02/90) <br />