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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I I III HEALTH DISTRICT LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION ' <br /> Car.�w:� <br /> Original Source: 5a:% Sa - V42-5 kk ti Telfephone: ( ) <br /> 4rr�- 13L(d <br /> Re orting Agency Name: <br /> Agency Contact: �a.:d GAr,k it X01. <br /> g Y Telephone: ( ) 3 <br /> Address: 16-k V20. V$Ox zaov, 1, LA <br /> C. LOCATION AND DATE OF DISCHARGE- ' <br /> Qt1- COO CWv CA-C- �k�� twt� <br /> Location: 1 Lo. P-.-J Lod: S-ix1K o,: <br /> .y <br /> (Best PhysicallDescription) (City or County) <br /> Date cf Discharge: <br /> Date Notified: Z 14 i} ` Time'skwa�� <br /> D. RESPONSIBLE PERSON%BUSINESS F;, <br /> Name of Business ZSC Ll—; ' A <br /> Contact Person: Telephone: ( Zoll Is 1,s } <br /> Ph si t... kd ��d; I; C Fi gS2-q I } <br /> y cal Address : ���� <br /> E. DESCRIPTION <br /> 1/wd�. ,r o.r^i3 4ar1c kel�qr.4. y� <br /> Type Release: <br /> Volume. ,i , <br /> { <br /> Chemicals : <br /> k <br /> j.: <br /> F. ACTION TAKE14 €} <br /> V ;�e cl U,., a.1t�..Z�� �. Irl o...rG ��'.o�� iP,>,a -w.�o�,....a'�:o..., �- •1. .c:1:a ;vv.• o,d:� - a <br /> aS eS5 ^n° JiY�- Li. 5/1\,e► {-Ce <br /> C`l ��f (?1111ti ' t�Xy�ny cs' L[ r4tt'Y1I�14�ICL } <br /> 7 ,r <br /> i <br /> :j <br /> i <br /> u <br />