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y`. SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> Q' <br /> A. EMERGENCY LEVEL: Ib II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: 0 ef",2/ 0 Z— Telephone: Qo7, w k- 3V G k <br /> Reporting Agency Name: ea lhcr , c,, �, L;z hli•4//� <br /> Agency Contact: Telephone: Lu7 V&8-3 Y4,,L <br /> Address: vc- .r / rA <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 07/& F, `n/„� r ,✓�,,e / �S��o�, r9 <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: <br /> Date Notified: /o v ,Y% Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business - Lac'/ IVOI?le- <br /> ContactPerson: 7011n Tclrr Telephone: av9 ) `/6 '" 23 CYLI`/0 <br /> Physical Address: ---2ZI& /r3 <br /> E. DESCRIPTION <br /> Type Release: /_/„crzrl/,�.„rr/Je%cs� <br /> Volume: //l�rr >�✓n <br /> Chemicals: <br /> I ACTION TAKEN <br /> //)/licca '<"rl/! >i/.va %c'n i/ '16?A ,L Y/mooc <br /> //Lc- Ay C/F/Ci �•,/n.0 <br /> /le <br /> L' ✓ <br /> EI-I 22 03 (Rev. 7/89) <br />