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i rr <br />SAN JOAQUIN COUNTY „1 <br />NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br />HEALTH & SAFETY CODE 25180.7 <br />C(D <br />[Rye <br />A. EMERGENCYLEVEL: I II III PHS -EH LOG #� <br />(Circle One) <br />B. SOURCE OF INFORMATION- <br />Original <br />NFORMATION_ <br />Ori inal Source: <br />g �' �����`�l�i»ey Telephone: <br />Reporting Agency Name: u�"I 4o&,�q [Z ��/S <br />h <br />Agency Contact: �cr�v✓ �f ���Telephone: (2°S) -4 <br />Address: A(4? S �✓/��r' S-?�% <br />C. LOCATION AND DATE OF DISCHARGE <br />Location:-....,_ J7F/ 1 � <br />(Best Physical Description) (City or County) <br />Date Notified: -/j c Time: ��©d q' <br />D. RESPONSIBLE PERSONBUSINESS ^ <br />Name of Business a✓l oma" <br />Contact Person: Telephone: (_) <br />Physical Address: ,l /` /�/ ���/�r/ l.,%f��7 e 44,-7 �4 <br />E. DESCRIPTION f <br />Type Release: <br />Volume: <br />Chemicals: <br />v <br />F. ACTION TAKEN <br />- ��r�/P✓ s `�� tom- �✓'/� .�x ��v�� �' <br />detf'r�lii�C �� C i?l�/Lie art �( /�iiLL/' L� c�- �or�I� c-,���► <br />R <br />EH 22 03 (Rev. 7/89) <br />C/P7 N1 a - " <br />