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SAN JOAQUIN COUNTY �� ' PJM <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE / <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVE: I J 0.7/ <br /> (Circle One) ✓ II III PHS-EH LOG �� <br /> B. SOURCE OF INFORMATION <br /> Original Source: F� �rt,J7� Telephone: (2 _!2z5 - 5%le <br /> Reporting Agency Name: a? <br /> Agenry Contact: Telephone: (2ye, 6! ;yya <br /> Address: /60l y/l7PlJaJ r{ y A47 re <br /> C• LOCATION AND DATE OF DISCHARGE <br /> Location: 3`/37 S A�.y., 7` / &h�, <br /> (Beat Physical escription) (City or County) <br /> Date of Discharge: SA.,know✓ <br /> Date Notified: 1/1 /yo <br /> Time: —B• SUgM <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business )? r,> <br /> Contact Person: me <br /> Telephone: <br /> ti —Z�,j -o/60Physical Address: <br /> CA <br /> E. DESCRIPTION <br /> Type Release: U <br /> Volume: <br /> Chemicals: 6.eA%o/rye <br /> F. ACTION TAKEN <br /> EH 22 03 (Rev. 7/89) ' <br />