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" SAN JOAQUIN COUNTY <br /> NOTIFICATION OFHAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG # _ - <br /> ircle One) <br /> B. SOURCE OF INFORMATION Telephone: <br /> 39 Z <br /> Original Source: C T � P (---�" <br /> i; <br /> 3 017 9-1L-6 »eE <br /> Reporting Agency Name: <br /> �� 4 Telephone: <br /> Agency. Contact: �i�lL fr9 4 <br /> Address• ��- s`T` Sic flu 4A <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: O� 1 /kU`' 7',' Gam' <br /> Best Physical Descri tion)'. / (City or County) <br /> ( y p y - <br /> Date'df Discharge: <br /> Date Notified: q Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name'of Business ��� 0� j . <br /> Telephone: / � <br /> Contact Person: K Q S p (�� <br /> 3hJca ,fir Rnvf-R A 5 G <br />! Physical Address: - <br /> U <br /> E. DESCRIPTION <br /> i; j�tfn fes!Z <br /> Type Release: _ <br /> Volume: <br /> Chemicals: <br /> ViC:W I1�S+rl�7 oil ,I -trys'o.� o�ZS4i►t L!'i rtC� US'r�"ToslCl l <br /> GirCtxrg-�w�e'g� . <br /> F. ACTION TAKEN <br /> I� rte- R� vGT F.� -TSN E.�r v vL zv'l / 4v1r�� TF <br /> Sar[ � 17741-+1N19�T/o�/. 115 TCp�I`Tv¢�`t;.rnlTl ce�t-Gdr, <br /> 72� <br /> n/J-TiB- BASE . ,�r✓.2T'KE �.7v vES7't�7'rniC/ ,¢f�l� l2Ei't Eo��'io <br /> II i4 v/R F� P3 =/ csu� vv' Ge//�cv G <br /> i <br /> EH 22 013 (Rev. 02/90) <br /> F <br />