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• SAN JOAQUIN COUNTY • -� <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE- <br /> HEALTH & SAFETY CODE 25180.7 (t <br /> A. EMERGENCY LEVET II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: 6,'IIl H 6c., lko se v Telephone: (aa9 ) 416k-3113 g <br /> Reporting Agency Name: <br /> Agency Contact: keWi`CL vgLO J, Telephone: db6 ) yLzfz'3y32r <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: a3 ,moi I<o Cl S. SaiJU Fx, <br /> (Best Physical Description) (City or4 ount <br /> Date of Discharge: q��P1�/vtJ <br /> Date Notified: S- O} d _ ( � Time: 3 , DU fJyYl, <br /> D. RESPONSIBLE PERSON/BUSINESS vI� <br /> Name of Business - - L e&e /Y I a <br /> Contact Person: D Wt,"- S, � i� Tele hone: (JQ <br /> Physical Address: a 356 9 -S, <br /> E. DESCRIPTION <br /> Type Release: G�i12 kQ� <br /> Volume: <br /> 0 <br /> Chemicals: a <br /> F. <br /> hr2e, q -s'-moo-9/ <br /> D 6141,�It JG A7 <br /> kj <br /> f <br /> S f ` <br /> EI-I 22 013(Rev. 02/90) <br />