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SAN JOAQUIN couNn <br />NOTIFSTION OF HAZARDOUS WAST— DISCHARGE <br />HEALTH & SAFETY CODE 25180.7 <br />EMERGENCY LEVEL:c) II III PHS-EH LOG # <br />( ircle One) <br />SOURCE OF INFORMATION <br />Original Source: -Roi> Telephone: ( 2CCt )q1-1-4-s300 <br />Reporting Agency Name: ---01-)1 I ca_S <br />Agency Contact: 42-ncej Telephone: ( zog ) r14-(0-3442.-6 <br />Address: 4}44S- 1\1 Jr:n(1- (,t (-1 qc-B-7 o 3 _ <br />LOCATION AND DATE OF DISCHARGE <br />Location: 13 ,,t-D . ‘x)pr5i-4 (Ly-x-m,r 5T / <br />(Best Physical Description) (City or County) <br />Date of Discharge: <br />Date Notified:r_71 5-1 (c) Time: <br />CO <br />a-on <br /> <br />RESPONSIBLE PERSON/BUSINESS <br />Name of Business P CEDF)-R HCDCS <br />Contact Person:7,0,c-, CT() ?-7 Telephone: ( 1213P1) AR 4-14 <br />Physical Address: 1 ,0 H QC-7-Tnkt 5-1-•) 517r---1<-70 <br />DESCRIPTION <br />Type Release. UnaLL"---hCri -c4 rria- ove rec.{ f <br />Volume: Y" necOn <br />Chemicals: diec-e <br />ACTION TAKEN <br />`P-1,L r-ervr St Srrr& i 01 tae ±r) ({,2_:+erm-uckiz_. <br />4e. rk_v-to kJ- r,r1-:\- s <br />\ Li t-in a0p (-0 0,-; al`77 PrA [A] a 47)(1( rvvvIri, . <br />C) <br />Siz)c-f<rzo <br />EH 22 013 (Rev. 02/90)