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f SAN JOAQUIN COUNTY 4 <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE . <br /> HEALTH & SAFETY CODE 25180.7 <br /> / <br /> A. EMERGENCY LEVEL: O II III PHS-EH LOG # - <br /> / fg ' <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: pe-, Telephone: <br /> Reporting Agency Name: <br /> Agency Contact: alv Telep one: (20::; ) 4kcR -347n <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE a <br /> Location: SSS tA). Nam or a„o <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: - --+�79.190 <br /> Date Notified: Time: `- 2' PM <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business -d i j t k SixnP <br />;Q lin Contact Person: ,, { r-rri rg:,�:h Telephoner ( �, ) 635'1-5t ono <br /> Physical Address: 'f S l09 EY +v�raa�e s+ -,, ,,, + C ✓+ q 4��S2 <br /> E. DESCRIPTION <br /> Type Release: Qr,)?v,3thn,rr7-e,-1 relva= <br /> Volume: _ aAlIrns <br /> Chemicals: - V O.L. C ra�nl i r�o <br /> F. ACTION TAKEN <br /> Q n1>A„�, c�n,n ��iit 11 (�,2cs11 to 'rP„n vw fG�o <br /> Y Y <br /> f�nravv� i,�rvA �1i I h8tro �� Inael Ot t a e- r-+-} F1rrl hn-z- r (n.(/1 <br /> t,uasrty. haiilon 1 tir+f, r s, 1v� r �r�� ,anr , t�tl iuir�-ci +n <br /> (111-r7rrni the nan Air, �1-- P 3 1tyP1r C� e-a ofawincy-,fes � <br /> -C24L)i i-t-d b( r 4+V aonrnnn��r wr y a o ry <br /> EH 22 013 (Rev. 02/90) <br />