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SAN JOAQUIN COUNTY ` <br /> NOTIFICATION OF HAZARDOUS WASTEtjj <br /> HARG <br /> E <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG # <br /> ircle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: (ND Cl!q'L-- Telephone: <br /> Reporting Agency Name: Pis' <br /> Agency Contact: a5-P—Y Telephone: (Log) y6 — 3 4/O <br /> Address: an �oajuin S <br /> C. LOCATION AND DATE OF DISCWGE <br /> Location: (o D! E. Ke,�+L -man LLn / <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: UN) m ow(j <br /> Date Notified: Z�'q I Time: �l' D A-M <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business U N D C-A L- <br /> Contact Person: 6A- OK K Q L n y e2 Telephone: ( 1 ) g 7 ' (o 0 <br /> Physical Address: IL00 rbt,) Co-n\ on �ctC� 00 <br /> E. DESCRIPTION !an Pam'on C-?� 6t q 5 8 3 <br /> Type Release: L A f, Ca LS oVi 2e-A >Pon -�L y)K Ve,W 6 c� <br /> Volume: N N D w tJ <br /> Chemicals: <br /> F. ACTION TAKEN L <br /> �U I�-�'�l.��V S S rn 2-r��" ! �� /�-2. ►/•�- ! tie 'I � <br /> d1 4f.ym t h.2 44-u na.4-wYP c ,+4 o-f C4L() Zvi i n ei c a� <br /> V'e v r c a <br /> EH 22 013 (Rev. 02/90) <br />