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/ l ) <br /> SAN JOAOUIN COUNTY <br /> I NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 D <br /> • <br /> �0 <br /> K; EMERGENCY LEVEL: II III <br /> PHS-EH LOG # <br /> (Circle One) <br /> Be SOURCE OF INFORMATIQN� <br /> G ✓G1lUp �!) Gr , Gil / Telephone: (- ) <br /> Original Source: ) G, S z7 <br /> Reporting Agency Name: S �a CCvn <br /> � zd y�� _ 3Y� <br /> « Gy f�< f Telephone: (_) 0 <br /> Agency Contact�,C� �a <br /> Address: O zr/ <br /> Co LOCATION AND DATE OF DISCHARGE k � <br /> Location: (City or County) <br /> (Best Physical Description) ( tY <br /> Date of Discharge: <br /> Time: <br /> Date Notified: <br /> D . RESPONSIBLE PERSON/BUSINESS <br /> «� <br /> Name of Business 9 <br /> /J , , / /�, ,,,,�„�� Telephone: �) <br /> Contact Person: re� fSS <br /> Physical Address: ' <br /> E. DESCRIPTION e <br /> 71WType Release : <br /> v n li nc^ <br /> yiJ ✓I <br /> Volume: <br /> Chemicals: <br /> P U vr'� rX4i��s <br /> F. ACTION TAKEN <br /> ✓'C6 L i9 t "� 7�/� �//e <br /> ii � i� r`IIG�s' 7?�7 IAC /r1A � <br /> EH 22 03 (Rev. 7/89) <br />