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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 rr <br /> L�� U <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG # '71-22 <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: &-5615 �� 1V 1i2 �1 tKl�f�2. Telephone: �/( l(o ) 702 — 21/0( <br /> Reporting Agency Name: 09M-c,174 /n/yl S l ON <br /> Agency Contact: gfe,7 SCC O(Y�, Telephone: ( Z0J ) _-_- 48 ' W/ <br /> Address: P 0. z6n 511Y t6A (r (24 q520 � <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: (o/?,l /C <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: ( I 6Idw. j <br /> Date Notified: 'l 2 q/ Time: l Oy 2m <br /> D. RESPONSIBLE PERSONBUSINESS <br /> Name of Business )OtgcIC G <br /> Contact Person: [)07�Ll U,u7� trj ' Telephone: 45/— Z-791 4L 12:Z <br /> Physical Address: /?240 pxj 3 aai_� 56"IrS qtj 0)-;17C01(W--) C4 <br /> E. DESCRIPTION �1452d <br /> Type Release: l (1J A Ab9'-PU2-tF7� <br /> Volume: f t 11 &I(Y t 1 <br /> Chemicals: CC/kS0(a ftp <br /> F. ACTION TAKEN <br /> r 2nu,ili) .A91L I , G6WAt5, etu- Re-VL" r Arne vGe rz�m <br /> l7t% �,✓3Sn/an h� C C� S?77L (s2n�,��1 �S6T - M <br /> J <br /> EH 22 03 (Rev. 7/89) <br />