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TT HM <br /> IX A,Documentation for Unauthorized Release <br /> SAN JOAQUIN COU ` <br /> " NOTIFICATION OF HAZARDOUS WASTE I HAR <br /> HEALTH & SAFETY CODE 251807 <br /> A. EMERGENCY LEVEL: O II III HEALTH DISTRICT LOG # -'0/ra— <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original, Source: Spr.] Telephone: (An) --:3,q <br /> IL <br /> Reporting Agency Name: <br /> Agency Contact: enJ Telephone: (19a) <br /> Address: U001 <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: r <br /> (Best~Physical Description) (City or County) <br /> Date of Discharge: — Uova)Qwo <br /> Date Notified: <br /> _.. .._ Time <br /> . D_ RESPONSIBLE PERSON/BUSINESS <br /> Name of Business L lJ5 <br /> Contact Person: <br /> - L. Telephone: j <br /> Physical Address: <br /> E. DESCRIPTION <br /> l <br /> Type $e lease: <br /> MA,"LLV-4c,�(— <br /> -G �..t� `�L�C2 r—r rt. t•� Sz1GA~�c,� �jrZ ( I.t'£S t, <br /> Volume: (f y <br /> Chemicals: <br /> F_ ACTION TAKEN <br /> t 5 r3�i►-�� ��>� hr -mss`�tn�E �� � 12�P et���� <br /> Qau y r IT4-171�- 10171;,11 111 <br /> i <br /> i <br />.i 3 <br />