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0 SAN JOAQUIN COUNTY 0 <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION / <br /> Original Source: \-7* z�?611�- Telephone: (�j ) 5%�r ��/1� <br /> Reporting Agency Name: xz- Jnncr/� c,�'!t Gti v/rnvarrati�cl llrf* <br /> Agency Contact: r'1,r4 f-(yi, HMn.� Telephone: ( 222- ) _ _ %? - 3`/yo <br /> Address: AGO( F' Pd, x An09 �OcHo- (4 <br /> C. LOCATION AND DATE OF DISCHARGE <br /> N,NR i Arv»H <br /> Location: _ b=•r / <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: I SFky-f <br /> Date Notified: //q 16 Time: Id <br /> D. RESPONSIBLE PERSONBUSINESS <br /> Name of Business SN L L LK <br /> Contact Person: Jac k H 41 N PS Telephone: = -20L7 <br /> Physical Address: Roati Lo,-P 1 �Xzp r,Q <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: 5500 f,) <br /> Chemicals: <br /> F. ACTION TAKEN y <br /> ~I`IG" 4 ! �e S-fnrm Q yi rraAf Rr05�nn <br /> he <br /> �p � L./�r _1_ n��,v�: r /e r,, 1S'if uSs•c/MLP r <br /> _ rF+(oarW"%f lr� C{('T�"f'ia91iJ.? -fM /.1 aTrnh� Qr-r`�( hcT�"r-'� C!)�IUk1rArmT�d,v C/.$ <br /> / <br /> _(f",i.(r�^Pr�,G ID Li -411 n TPr, IGT(YCe QrtPNCI� <br /> I i <br /> ti <br /> EH 22 03 (Rev. 7/89) <br />