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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180 . 7 <br /> CDC— <br /> A. <br /> A. EMERGENCY LEVEL: CI) II III HEALTH DISTRICT LOG # Oma' - d <br /> 6 <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: Chni s T1-L,IN� Telephone: <br /> Reporting Agency Name: SJI PD <br /> Agency Contact: Lupi Cofiu 110" Telephone: <br /> Address: �{a l taN l)PJ SJ k Iv gsao l <br /> C. LOCATION AND DATE OF DISCHARGE y <br /> Location: 7 700 mnT-jot'd -� N E � or tq ly St KN <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: 1,(LN <br /> Date Notified: f 2_ - 1 7' Time: 41- <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business qShEdl <br /> Contact Person: C �^� �r'ra Telephone: <br /> Physical Address : 72(10 wtefnM4 C+ <br /> E. DESCRIPTION <br /> Type Release: U(7 Cwt ( ori zeoL � je.CkSe, <br /> Volume: WAMOwN <br /> Chemicals: !;-ctS �j,•�C �',/DP (jvX,A)oy1,) <br /> F. ACTION TAKEN <br /> S/C� GSS�ss �•.9 G� 1� 6P l r��l!/�rr� �o �P7�I'l�lli�C ;� PX1 r�-r O <br /> &ZA-&,W;A1a//OA) 4s �'< "IT /'fc� 6l OLAao lleve( Irc a�r orl <br />