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b 6 1 <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE.. <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL(I II Ill PHS-EH LOG # ®� <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: . P S-rA 'LEV Telephone: -17– <br /> Reporting Agency Name: -��"i✓T a i ,� i� I- ��(,TI 1 5► 12v�G�S <br /> Agency Contact: i�o ks N A 1l r,,P A 6 Telephone: Q4L <br /> Address: 66 X 20 0�I 7a 70rJ, 6A- %s-,?o/ <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: �50 7246 v gLyo / <br /> (Best Physical Descript of n) (City or ounty) <br /> Date of Discharge: �� o�✓� <br /> Date Notified: 2 �"�—� O Time: 6y.f�U•4-M <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business <br /> Contact Person: ® ' T� s Telephone: <br /> Physical Address: -50 Wit/ 9SIR 7K <br /> E. DESCRIPTION <br /> Type Release: - VA�R <br /> Volume: <br /> Chemicals: <br /> F. ACTION TAKEN <br /> -SO®�4 �eSGl�/S �/`� Ci/�oCf ` -� ..� .dQ.��® Tia AJ evt <br /> 9 <br /> /se 62 <br /> u�E f•�c� 1 Pi l/!I G91� G Gt Gf �i1��� <br /> EH 22 03 (Rev. 7/89) <br /> i' <br /> s <br />