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twe <br /> SAN JOAQUIN COUNT <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:0 I II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: Telephone: 2a�i yG8''3JIW <br /> Reporting Agency Name: -PaL, -er.1 W. SerJrcr ENvrrzw,„o�, : FH.. 3; <br /> Agency Contact: a ar(r s Lv. fi Telephone: (,�oq ) -- %T-3q4'6' <br /> Address: •Cl. R,44 2 007 C ."75,Z,9 <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: /9d33 F, Yaw ism / rl'o wp4s4 CA <br /> (Best Physical escription) (City or County) <br /> Date of Discharge: ti "m-" <br /> Date Notified: _It 0_ Time: T ,2-0 A m <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business C <br /> Contact Person: Telephone: (202 `��7 <br /> Physical Address: <br /> E. DESCRIPTION <br /> Type Release: A(t I <br /> Volume: <br /> Chemicals: er.=r./ �f l► o�ro��r-f�n•�x <br /> F. ACTION TAKEN <br /> lark re""+ Je.l 'scarf rte,, tfs Pva'( Sot f <br /> Px�°..� A �Y�?Z!�.�-{ia.� G1s !�'ii��t'Y�� �r 'fes ,G�ot1�'✓ri-�fff- ,,. <br /> r4!2 <br /> EH 22 03 (Rev. 7/89) <br />