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SAN JOAQUIN COUNTY ..1 <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE . <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:/ H III PHS-EH LOG # U r 0' <br /> cle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: Telephone: [ ) S;f-7 <br /> Reporting Agency Name: �i 1 H7LC I-!>,c f l{ <br /> Agency ryContact: <br /> . Telephone: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE 47(,-,-- <br /> Location: _ t?,Ci S . (�r ! / <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: i,i r+ALI^-0-y'v <br /> Date Notified: bf!,/ ac Time: <br /> D. RESPONSIBLE PERSON/BUSINESS , <br /> Name of Business <br /> Contact Person: 07-g))N!I r r N o—j Telephone: 4 <br /> Physical Address: '7 (-f r(LrA t nn -12n ✓r)r-, 51. ti k?r nn C,4 C yr2t � l <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: i I r L" <br /> Chemicals: ( = <br /> F. ACTION TAKEN <br /> r(-3 (a "C" i d I fcle� r;�1 <br /> F^n—14 -V0 In,I <br /> EH 22 013 (Rev. 02/90) <br />