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• SAN JOAQUIN COUNTY • <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: 0 II III IS IPl OG # <br /> (Circle One) <br /> U - <br /> B. SOURCE OF INFORMATION <br /> Original Source: su /mss Telephone: <br /> Reporting Agency Name: <br /> Agency Contact: Telephone: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: AjjW F Go,irsa. <br /> (Best Physical Description) ' (City or County) <br /> Date of Discharge: <br /> Date Notified: 1,,-,7 -yam Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business <br /> Contact Person: Telephone: ( Y ) <br /> Physical Address: f C «ate 9c P <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: <br /> Chemicals: C` L!u /66,7re z,; <br /> F. ACTION TAKEN <br /> 6a he c e s s civ /v ele Cc . ;--c <br /> EI-I 22 013 (Rev. 02/90) <br />