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SAN JOAQUIN COUNTY <br /> NOTIF-7 'TON OF HAZARDOUS WAS-­ ISCILARGE <br /> �4EALix & SAFETY CODE 2,),�7 <br /> A. EMERGENCY LEVI310- 1 II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: Churl+P-c', ,r,,� Telephone: (20? y61-3yyd <br /> Reporting Agency Name: � "' J107t4w LzSepoces <br /> Agency Contact: �.�rr r��s �U N� Telephone: 2d q6j 3glo <br /> i <br /> Address: -y�'_ N �nN � Q'(.�(� c; r (c'!'D.r--' <br /> T <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location• ( 00 N. (,)���oN (n1�r / c-k-�api <br /> (Best Physical Descriptio (City or County) <br /> Date of Discharge: Q K,12ou ) <br /> Date Notified: _7 Time:Time: - 30 PM <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of BusinessC--O---cl <br /> Contact Person: R�c(c,- 11•.) s _ Telephone: t�66 2!22.7 <br /> Physical Address: 00 ;,) 6' <br /> E. DESCRIPTION <br /> 7pe Release: u �� <br /> Volume: <br /> Chemicals: •C'�m l'E'llMl 0 nhaN t <br /> F. ACTION TAKEN <br /> - � k- 9`P •t�C � � f_'�a (�s fipU•P��' (�N�.yY�11�v�d� , <br /> P" ^ zt <br /> �Sit�R' <br /> EII 22 013 (Rev. 02/90) <br />