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SAN JOAlUIN COUNTO <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVE II III P <br /> (Circle One) HS-EH LOG # <br /> B. SOURCE OF INFORMATION <br /> Original Source: Q� ti�"'" Telephone: 39' 0 <br /> Reporting Agency Name: �Z" <br /> PuG�(iL �nlfti Sem'/<Gf-s <br /> Agency Contact: Ll0r(rs u,^,'f" Telephone: (o <br /> Address: D E'. l-(��P I�tn r-� rl� Hca<mQ� (",A q; 0 <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: / N <br /> (Best Physical"Description) <br /> y P n) (City or County) <br /> Date of'Discharge: ._., <br /> Date Notified: Time: ®. Z�M <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business - SsAarmb <br /> Contact Person: JIA"j P..r Telephone: QBE. <br /> Physical Address: S6eW- <br /> E. DESCRIPTION <br /> Type Rebase: <br /> Volume: r/Ai,I�r�N <br /> Chemicals: Otft&Atv g <br /> F. ACTION TAKEN <br /> a�ft U s�•r <br /> oeq <br /> .' _ �rn�.%mac c u . �i+er �lR•� <br /> a <br /> EH 22 03 (Rev. 7/89)' <br />