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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> Health 3 Safety Code 4 25180.7 <br /> A. EMERGENCY LEVEL:p II III Health District Log f j <br /> (Circle one) <br /> B. SOURCE OF INFORMATION /� <br /> Original Source: �u ct�4 GP Cn1u.MCC, Telephone: (�) q& - ao <br /> Reporting Agency Name: E� _+p u kz c Qj lkPa,�-& f' <br /> Agency Contact: a � <br /> - r(-'VuC �wLQ ., Telephone: ( ) <br /> [_ <br /> Address: 1&01 , /.�C��,-C�C 4j 4op, C7 I�Li, c'S,9OS <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Date(s): /G(ihY�J Time: 6f,-M &90-V4� <br /> Location: 3 �� /Phys1��J ip i �- J� 7 Y1 / .S J. � ) <br /> Best PFi s�cal Descr ton ty or Runty) <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: i PS !^UC/t/! !? q <br /> Contact Person: �r Inr S (i //;rs /Telephone: /(a .4 p <br /> Physical Address: 1 / � � u✓v �1� �� l-IC�YL �/gysaP5 <br /> „ <br /> E. DESCRIPTION <br /> TypeRelease: <br /> Volume: <br /> Chemicals: <br /> F. ACTION TAKEN (/ <br /> ,P: pr l i nL P4 jv fir^0 nA s �014 <br /> �uus�e o; l /�4 e�r'sco , JtP ciyt s�oe C, <br /> )Lb c�i > / Q- �1L e >7 0{ice ct- . e,;r�- We <br /> as reR.a : �P� . bOq VI�P Q �e <br />