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yD <br /> 'b <br /> SAN JOAQUIN COUNTY o <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:: I1 III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> ,Uorak-A *wV Ij IV, -6V-- Ivkvna-hon&l Tcr—hr'0 <br /> co5,f Cdt t VAI&7 <br /> Original Source: 4s g W4.. . Telephone: ('jt!5 j <br /> r nc z G4 gg6553 <br /> Reporting Agency Name: <br /> Agency Contact: Telephone: (___� <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: SOC-::? NA1CggtllnSfI GVH <br /> (Best Physical Description or County) <br /> Date of Discharge: oNCt ou.)h <br /> Date Notified: Time: �d <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business - Lac-Lfi-r- PicA I <br /> Contact Person: ���'-e. Telephone: L <br /> Physical Address: tl� �0..�T Re 5 �XtCVr1W�Qt'I�Cl4 q58�/ <br /> E. DESCRIPTION f� <br /> Type Release: <br /> Volume: OA Ovt/r, <br /> Chemicals: <br /> F. ACTION TAKEN <br /> h c9�� vv� o%/ed <br /> hav e <br /> scn%� vo,-Q-x& 1�� vvL'ic) <br /> EH 22 013(Rev. 02/90) <br />