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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVE II III PHS-EH LOG # -6 <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: �] ,, " Telephone: L'= .) 6 —E f-(yU <br /> Reporting Agency Name: r � rf< <br /> Agency Contact: ('f��,��(p� , � Tel e: �) y� —3 y1I P <br /> Address: ', U rr C?t?2tn� <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 3aoO Ly� rlcx5 !Q. ,� / LIP <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: CA Vj r <br /> Date Notified: I U Ili C30 Time: _ 3,`i S EL5 <br /> D. RESPONSIBLE PERSONBUSINESS <br /> Name of Business <br /> Contact Person: , �Nr�y L4:L Telephone: <br /> Physical Address: S� GJ. ►"7�►i,--.� �$ }- .,fit-,( ,rx <br /> E. DESCRIPTION <br /> Type Release: EZ 11 r- r' <br /> Volume: <br /> Chemicals: t �f"^1'���1��Y, ����Ir�Cary <br /> F. ACTION TAKEN <br /> __1{'��i�(lam ri i-Pn✓���'�' , <br /> EH 22 03 (Rev. 7/89) <br />