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i <br /> SAN JOAQUIN COUNTY \/ <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> �HEAI.TH " & SAFETY CODE 25180.7 <br /> A: :•:EMERGENCY• LEVEL: II III <br /> (Circle One} HEALTH DISTRICT LO - <br /> G <br /> B. SOURCE OF INFORMATION <br /> Original- Source: (', O,S, Jot KNiG� Telephone: <br /> Reporting Agency Name: P" kl;, �R[7F{ �� � - Ltj;q Ch cc <br /> Agency Contact: N Telephone: { ) !�( 3 0 <br /> Address: �+ 0 �d d S70tlr/ �j -� <br /> C. LOCATION AND' DATE OF DISCHARGE <br /> Locations.: ,� L / _R-r�70i✓ <br /> ( est Physical Description) (City or C nty) <br /> Date of Discharge: 41A1Ato7,dA1A1 <br /> Date Notified: --�9 Time: O ,Va <br /> D. RESPONSIBLE: PERSON/BUSINESS <br /> Name of. Business F ire <br /> Contact• Person: �F'�R V kl 5' Telephone: &2) v/z/ Od <br /> Physical Address-..-'. /V"IN f% <br /> E. DESCRIPTION <br /> Type Release: ol�/ <br /> Volume: <br /> Chemicals: Q ' <br /> F. . _.ACTION TAKEN. JAI�le 4l 7 _A <br /> rLi� ie.� Sale dSSe55"no - _ 607// be V"44 rite.../ 4V <br /> cciR-ccl ke o mora� re4yt, r <br /> _e <br /> Co -se of his nfft.-.., ..__. emPloyee who obtains infar utf.... :_ .�_ <br />