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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCCC F L <br /> HEALTH & SAFETY CODE 25180.7 <br /> rc- ) <br /> A. EMERGENCY LEVEL II III PHS-EH LOG # — <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: L <br /> A-ka Telephone: Gy `f(ae- 3 �-3 9 _ <br /> Reporting Agency Name: c , <br /> Agency Contact: Telephone: U <br /> Address: , /�, (2C2� �'�'� i , CloqC. LOCATION AND DATE OF DISCHARGE <br /> Location: '76 X76 <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: Jy�� <br /> Date Notified: / Time: <br /> D. RESPONSIBLE PE SON/BUSINESS <br /> L <br /> Name of Business <br /> Contact Person: Telephone: 7 <br /> Physical Address: / Fc, R q4n 6yu <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: <br /> Chemicals: �Z �. ►�, (�/3 tYE�c <br /> F. ACTION TAKEN <br /> 10-44 <br /> y-AYU Q� <br /> EH 22 03 ;( ev. 7/89) <br />