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a w { <br /> SAN JOAQUIN COUNI- <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> • r , <br /> A. EMERGENCY LEVEL TI III PHS-EH LOG # �0—0/ <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: c •k 14, Telephone: <br /> Reporting Agency Name: � N urr'r ,riN � �,, �, ,�,�;�rn,,,tyr,�• rx <br /> Agency Contact: -Crt�`f Telephone: <br /> Address: — P.0. "�x �-�c�-k,}r�,J C,4 <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: () Y►�c�c��-fir�r�. PU� / _�- ter_IcA6 r.t <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: — //N�n ,•� <br /> Date Notified: — ( ��/f�D Time: - g'•3y �/M <br /> D. RESPONSIBLEPERSON/BUSINESS <br /> Name of Business /,ri..rc�FYsor� �Qi�iv�/P (,.,rn„nrfjD,J <br /> Contact Person: Telephone: L.9- DKPO <br /> Physical Address: ?,.,�l..r ��;� J)r/L•P ���. ,,,�, � , <br /> E. DESCRIPTION <br /> Type Release: � <br /> Volume: <br /> Chemicals: 4nP7'nAk1_ <br /> F. ACTION TAKEN <br /> 7aNk kerma <br /> 4-0 <br /> EH 22 03 (Rev. 7/89)' <br />