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' SAN JOAOUIN COUNTY • <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 c( <br /> A. EMERGENCY LEVEL: I II III <br /> (Circle One) PHS-EH LOG # <br /> B. SOURCE OF INFORMATION <br /> Original Source: ( `fA(tC Ek fir( L Telephone: <br /> Reporting Agency Name: _SI°ct.1 70P (Qu,Lt <br /> Agency Contact: <br /> Telephone: ( uyrj ) <br /> Address: -O U 0, Cts <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: �l Zo 3 l�. 11,14 .51– TR P.0 I I Ct4 ct 5 37� <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: I i VL Im k. II <br /> Date Notified: 'Z> I ZQ) IQ I Time: —_ • 15 <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business l AtJi�Ct� _ �� u� vC 0-1 P)P <br /> Contact Person: CUA <br /> Telephone: ( <br /> Physical Address: _�ZD3 <br /> E. DESCRIPTION <br /> Type Release: I I A R <br /> Volume: I ttJ ILt`(itJA1 <br /> Chemicals: I L 111�t�rt V����nn �nmPmnS� <br /> F. ACTION TAKEN <br /> L Y�tJa� C��Ziur`t wva' 7 ' tS <br /> NTY]N.f S.t.1J� asiem+ C�iLt1y� I U r CbinctvM 1 ,� <br /> 2(�lliya,rl �,'�12-Q�l,h}{� �,h'XS11Yl SY��Ya1N111.lvYln <br /> N'R� gS,C,�ce�..� ��, l�h,�Th �n•A„�bdN �.r'lt fin, I )� � <br /> u� - ��✓Y(1 i Q!$1�u ,oEf7)�� �KtS e,l <br /> J , <br /> EH 22 03 (Rev. 7/89) <br />