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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISd IARGE 100A <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: II III PHS-EH LOG # qD - d 3D <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: D r kx- L& 9 iCI4,,Qb Telephone: <br /> Reporting Agency Name: T64MC �� .Service <br /> Agency Contact: . 0di n a- Telephone: a2( y 7 ) —466' - 3�� <br /> Address: 1601 gooct _SfOG�C4-M i GA 95a0/ <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: !(9D�- 6 ,�„q. a� �� / -_ S f0 <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: <br /> Date Notified: Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business 00-1i h1rt?%eA- lV aiCr Seror'ce <br /> Contact Person: m• G- Telephone: a( 09 ) _ q6,4• 6311 <br /> Physical Address: 4 D2 �j C L-11 L <br /> 1 , <br /> E. DESCRIPTION <br /> Type Release: h�r;X20( t-c/e as C- <br /> Volume: sC- <br /> Volume: <br /> Chemicals: <br /> F. ACTION TAKEN So// .SG,. ler }�i�CPr l iI di c<i/e U R< )?r <br /> J o c ccs-,-ee.( <br /> F(,t.�her si Fe CLssesSme�f A)-; <br /> deferna.i rt.e. <br /> CLS r - ui,-eOC. 6 <br /> EH 22 03 (Rev. 7/89) <br />