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SAN JOAQUIN COUNTY <br />NOTIFICAi ON OF HAZARDOUS WASTE CHARGE <br />HEALTH & SAFETY CODE 25180.7 <br />A. EMERGENCY LEVEL:(� 1 ) II III PHS -EH LOG # <br />Pircle One) <br />B. SOURCE OF INFORMATION Telephone: (20 ) g35-32io <br />Original Source: � ick <br />Reporting Agency Name: <br />Telephone: (70q <br />Agency Contact: I ) 4lnF 34& <br />� <br />Address: 44 <br />C. LOCATION AND DATE OF DISCHARGE 14 <br />Location: � V <br />�—` (Best Physical Description) it �° r County) <br />Date of Discharge: 4 ' I -- l <br />Date Notified: <br />Time: <br />D. RESPONSIBLE PERSON/BUSINESS <br />Name of Business N <br />_ 7Tph2�0c9 3zf o <br />Contact Person: ��QH <br />) <br />Physical AddressZ0_ <br />E. DESCRIPTION <br />Type Release: 40 r1 SE ov a fr1�,k I�j Qr ,urs <br />Volume: _I <br />Chemicals: <br />F. <br />ACTTON TAKEN <br />EH 22 013 (Rev. 02/90) <br />