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.ii�tJ JUii�IU 1 N I;UUPv I'1' <br /> NOTIFICATION OF HAZARDOUS WAST'!: DISCHARGE <br /> HEALTH & SAFE`T'Y CODE 25180 . 7 <br /> A. EMERGENCY LEVEL: II III HEALTH DISTRICT LOG # 'Y7 0099 <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: 5_tCVG �✓ooC aro Telephone: (209) 369 -104/ <br /> Reporting Agency Name: ,San --J 0a9 U ir7 Lo Ca 0. I-f-11 <br /> Agency Contact: _ bb11/10. e-ra Y) Telephone: (,A ) L -6$-3q3-2- <br /> Address: 160 E. lla-ze-4br) . .stock-fan , Q• 76201 <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 14900 V, Nw -2- / L-o cti 1-5�2Q <br /> (Best Physical Description) (City dr County) <br /> Date of Discharge: Un k►loujjl <br /> Date Notified: 12-- /5--37 Time: 1. 00 P M' <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business -rowp'!- Par-P� t1 a I'i hOL- <br /> Contact Person: S-f�P_y� WOo(,La('� Telephone: (,n?o) q-10 j <br /> Physical Address : 1 "oo W Hwy /,2-, Loct•i 35� q"0 <br /> E. DESCRIPTION <br /> Type Release: Lin aatAo r-r ZecL r-e le CLS <br /> Volume: Uri knowyl <br /> Chemicals : Pe-+r-o le.om nv( pCaf �orlS <br /> f <br /> A <br /> F. ACTION TAKEN _ I <br /> F Gy1 Ge= 1' n4 0.ter __LI ct. i✓10. fon nofe-aL <br /> r i✓1 s i-rtee15 S Wl e.✓l+ 1 i rM <br /> klern o-F Sacfo. v(( ex-F"-rf- o <br /> 4-o be, o(x-+e-rrm i rte 0t. kr---fL r r-a 5 E,0-f- C V/21n/Q C 6 <br /> ctrlcL J. Co . FI'r-C Way' C�eYI. <br />