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•.� SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHAR&C{E <br /> HEALTH & SAFETY CODE 25180.7 rPy <br /> A. EMERGENCY LEVEI-6 II III PHS-EH LOG # 671-10-17,1 <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Or^ig_ ON <br /> inal Source: 4.7 411 Telephone: (( fiS) _ y� l6o a <br /> 0-14 z <br /> Reporting Agency Name: <br /> Agency Contact: Telephone: (^� <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 222 /V '/ 576C.CrVN <br /> (Best Physical Description) Cit r County) <br /> Date of Discharge: V)k,4joWIV <br /> Date Notified: 6-3 -71 Time: SU/ <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business � /yJ��2�cyt r1/ fir¢✓irtlG� �i¢�/� <br /> Contact Person: 4Z455Cro.-y ,"5'�LAR'ETelephone: ( dam) • �p3, <br /> Physical Address: ��� �� sr��' ��• <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: <br /> C emicals: <br /> F. ACTION TAKEN G <br /> .S23 <br /> 111 22 013(Rev. 02/90) <br />