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SAN JOAQUIN COUNTY <br /> NOTIFI�I�ON OF HAZARDOUS WASTb �SrCHARGE� _ <br /> HEALTH & SAFETY CODE 25180.7 / <br /> i <br /> J <br /> A. EMERGENCY LEVEL: (DII III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: Z;,/trs e! hc= s Telephone: 1v2 �sFr-aY7� <br /> Reporting Agency Name: '5�2n To4 �u�� a''- /,Ou 6l« /-lea //z7 P5 <br /> Agency Contact: Telephone: <br /> Address: v9,5- 'v, <br /> C. LOCATION AND DATE OF DISCHACRGE <br /> Location: /Sbis S- 3 / L ru6� roy , C.4 <br /> (Best Physical Description) (City or County) <br /> Date of Discharge:DateNotified: G-d1-• F0 Time: 1pi9�" •_ <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business ASCD <br /> Contact Person: l om�s �� s fvh Telephone: <br /> Physical Address: <br /> E. DESCRIPTION <br /> Type Release: Z—,2"72,oma. O�� <br /> Volume: 6',07//- ), > - -- <br /> Chemicals: 4E'.5-C,%Kos <br /> F. ACTION TAKEN / <br /> -f SiY ossC SS .�.-Pi a/ LJ�%/ Z o .i.er e=F: �y_ 7b G0(e Ae* <br /> ,l ,4c,P n cls PX fr elf Comer -rFi.y. i :�• CZS v�v c...=�� Lc. <br /> lCe, <br /> EH 22 013 (Rev. 02/90) <br /> r - <br />