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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> IIEALTII & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: 1 11 Ill PIIS-EII LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION�`�a/oma <br /> Original Source: sr,;i s /e s P s u/<s Telephone: ( zop)_y6d 3YCv f� <br /> Reporting Agency Name: %T 2,2 - P. /« A�-e irk V,cr <br /> Agency Contact: C'a.v/ Ca. Telephone: <br /> Address: iwi F. <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 3r;F N. �in»� / /o�E�>.�� 07- <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: <br /> Date Notified: S aS'FD Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business <br /> Contact Person: Telephone: <br /> Physical Address: - SmeL . <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: c���ifirou>n <br /> Chemicals: 64,c,,Le re,,.e <br /> F. ACTION TAKEN <br /> Px.Ci�� �s� L'c�i�rrvr>i>��io _r.c veoc c�/' «✓ /oc D i tt>trl f i <br /> EH 22 013 (Rev. 02/90) <br />