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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY C".7,-,- <br /> A. <br /> 18U 7 -A. EMERGENCY LEVEL II III PHS-EH LOG # ®– �-- <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: AeAP P S-M-rl-,S/ Telephone: ( /5) V4 7- 7– <br /> Reporting Agency Name: _ .sem✓To��u/;� �� . �,�. I is I- �a('p'I-� 5i2V�G=S <br /> Agency Contact: Telephone: (2. y� <br /> Address: 056X 2 0 0�/ =— �On/, �9- !S-00/ <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 3rD ,�; 7z4ey 9Z-t10 / •� 1 �� <br /> (Best Physical Description) (City orCounty) <br /> Date of Discharge: Vti&a 4 (n� <br /> Date Notified: 2 —."9-90 Time: S! 010'Am <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business <br /> Cootact Person: 2�41-D 7�TG� Telephone: <br /> Physical Address: <br /> E. DESCRIPTION , <br /> Type Release: <br /> Volume: <br /> Chemicals: <br /> F. ACTION TAKEN <br /> re V2a / r� rr a ® iia / rl-) <br /> /V& 96 <br /> – <br /> d <br /> ocj-4'ie LZ 7 We <br /> EH 22 03 (Rev. 7/89) <br />