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i✓ SAN JOAQ UIN COUNTY <br /> NOTMCATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL(3 II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: _g? js Telephone: <br /> Reporting Agency Name: � r•,� /'o:� i Pi6x� t a►ffl► SPiv; r�-E"P►v 8006 <br /> Agency Contact: f4s 1-4G;P Telephone: (&2 l _ !16J-TW& <br /> Address: _7P O. Ra ,2 001 - r Q5.2 n 1 <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: _7,50 :rh& <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: - U N k00wrJ <br /> Date Notified: 2&s-/q? Time: _ ' <br /> D. RESPONSIBLE PERSONIBUSINESS <br /> Name of Business Maria A) - /Ur Fri <br /> Contact Person: -„derrw_ ._ Telephone: (,2,0q ) -R3y-zm 3 <br /> Physical Address: .2 6 T' L4 <br /> E. DESCRIPTION -r <br /> G/�1L <br /> Tyle Release: <br /> Volume: G1 NKNoU.�� <br /> Chemicals: <br /> F. ACTION TAKEN <br /> r�7/f7 1`�ffrA� //1wfI J/ f�11v S <br /> 1 Hlai/r� 'Cf7lw t� dn 1 �t7a�►rir�►ec1 <br /> -76 cw/uPr f sjt cnsP mrd't�,%1 . <br /> .a„ <br /> r <br /> EH 22 03 (Rev. 7/89) _ <br /> i <br />