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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG # v l <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source:��ich��N 4a6-4 Telephone: (_____) <br /> Reporting Agency Name: -5i.o /,x.�>/v <br /> Agency Contactz �2 Telephone: <br /> Address: zxo/� <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: <Spp--Z ,/ &,, �c <br /> (13est Physical Description) (City Ur (�Uu,Il)j <br /> Date of Discharge: <br /> `Date Notified: _ 5V,- , - S�5 Time: <br /> D. RESPONSIBLE PERSONBUSINESS <br /> Name of Business _,�++ /�G ¢ E7 <br /> Contact Person: jo wn, Telephone: ( ) <br /> Physical Address: 23L/22 Crno � "S �r 3 <br /> E. DESCRIPTION <br /> Type Release: e/cl�rci <br /> Volume: 4,1-7 <br /> Chemicals: �r {/�/c •.� <br /> F. ACTION TAKEN <br /> z'O//Alli f M Y104 OS d4j :Yelice. 1�'e <br /> EH 22 03 (Rev. 7/89) <br />