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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: l ltCahx�� �D t �-hTelephone: (c�Oq) 2211—ZP07f <br /> Reporting Agency Name: lr UYrQ„ j �� �/��, <br /> Agency Contact: 06,L( /&t���, " Telephone: -3 LA <br /> Address: O / 7LIJ G 9�0 / S�C <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 11150 Fi �� 7 159—e <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: <br /> Date Notified: c( � 9 Time: - o 0 <br /> D. RESPONSIBLE PERSONBUSINESS <br /> Name of Business QS / ,'�'_ Q <br /> Contact Person: A OV1.Ps,9 X &t &,t Telephone: GW q �— 2i40 j <br /> Physical Address: ��'� c� �� ��` YI lcz <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: - /,r.wr.y,�} LLfZtiY� <br /> Chemicals: ZZ--pi <br /> F. ACTION TAKEN <br /> f <br /> CNc, a PSti cvc`' <br /> EH 22 03 (Rev. 7/89) <br />