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SAN JOAQUIN COUNTY <br /> t; it <br /> NOTIFICATION OF HAZARDOUS WASTE•DISCHARGE <br /> HEALTH & SAFETY CODEI 25180.7 , <br /> h <br /> A. EMERGENCY LEVEL: I 11 111 PHS-EH LOGS # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: fi5G/ rirr Telephae: <br /> Reporting Agency Name: 00/ <br /> is <br /> Agency Contact: ��vr . �t/.{ ;,- Telephone: I( ,} <br /> y- - 3 <br /> Address: zez <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: _V�5• ► G/a / s e6 <br /> (Best Physical D scription� (City or County) <br /> -Date of Discharge: <br /> Date Notified: z Z& Time: '�. =�J() <br /> RESPONSIBLE PERSON/BUSINESS , <br /> Name of Business `1 511 4 / j <br /> Contact Person: ,`/r��2s Telephone: yS ' C _S7 <br /> Physical Address: 0 C���G/G . I� �; z <br /> E. DESCRIPTION a <br /> �I. <br /> Type Release: �Qv n e Y7 <br /> /IOr✓ !�� <br /> Volume: &W - <br /> Chemicals: � . rn n I <br /> F. ACTION TAKEN !, : <br /> Z&a <br /> �y .� � . <br /> :-H 22 03 (Rev. 7189) <br />