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SAN JOAQUIN COUNTY <br />NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br />HEALTH & SAFETY CODE 25180.7 <br />A. EMERGENCY LEVEL011 III <br />(Circle One) <br />B. SOURCE OF INFORMATION <br />Original Source: C°�a2ee�eiuw <br />Reporting Agency Name: 4-k a <br />Agency Contact:LD <br />Address: D 9 <br />C. LOCATION AND DATE OF DISCHARGE <br />F" <br />E. <br />F. <br />PHS -EH LOG # G i ) 'O a S <br />Telephone: i� 1q `f -7 � O (p <br />(D, PIqS <br />Telephone: <br />Location: <br />/ (Best Physical Description) (City or County) <br />Date of Discharger <br />Date Notified: <br />RESPONSIBLE <br />Name of Business —( `�,V <br />Contact Person:��ic� <br />Physical Address: <br />DESCRIPTION <br />Type Release:....., <br />Time: <br />Telephone: (a4b <br />Volume: <br />Chemicals: Ae Alhl) n,Y K <br />ACTION TAKEN V <br />EH 22 03 (Rev. 7/89)Ao <br />v <br />