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SAN JOAQUIN COUNTY(-`H <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. <br /> EMERGENCY LE I II III PHS-EH LOC O <br /> (Circle One) # <br /> B. SOURCE OF INFORMATION <br /> Original Source:('' 'ir(,�� �A.�f-' � <br /> Telephone: 68-3 <br /> r � d <br /> Reporting Agency Name: NS <br /> Agency Contact: Telephone: (2 09 _ <br /> Address: JL 0 1 <br /> G LOCATION AND,DATE OF DIStGE <br /> Location:° y r,,, {,�,,r r -1c ► <br /> (Best Physical Description) (City. or County) <br /> Date of Discharge; uI-11k <br /> Ijate Notified: -L� Time: *;Z".S o �t <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business 4 ; <br /> cbatact Pemn; '�t�rr�P �t►u <br /> a� Telephoner (ZO? / -9-01Y <br /> Physieah Address: -- tU : Gerf k-�w <br /> E. .DESCRTPM- N . <br /> Type Release: Q-A JV <br /> Volume; <br /> Chemicals: <br /> F. ACTION TAIMN <br /> Nk t�emow•e�. Sa;I � <br /> �r/A e <br /> P <br /> EH 22 03 (Rev. 7/89)' <br />