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0 SAN JOAQUIN COUNTY 0 <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: II 1111 PHS-EH LOG # <br /> f2cle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: �2_ ^('T�/.fG/�p� Telephone: (c1 ) <br /> Reporting Agency Name: <br /> Agency Contact: Telephone: Wo q ) 31f37 <br /> Address: P, �C� 9S.2o/ <br /> C. LOCATION AND DATE OF DI C GE �'Yll2 G CL-.,Location: /WOO > / <br /> (Best Physick Description) (City or County) <br /> Date of Discharge: ( ✓ 9 / <br /> Date Notified: L-1 -f — ol l Time: <br /> D. RESPONSIBLE PERSON/BUSINESS hJ <br /> Name of Business <br /> �-(,� �,-�i2� Telephone: <br /> Contact Person: p (� <br /> 1 Fk�ln � �.�Y�P.e o� s�rl• � w — <br /> Physical Address: rt-�---- <br /> E. DESCRIPTION //-- <br /> Type Release C Nig TC <br /> Volume: <br /> Chemicals: �--! <br /> F. ACTION TAKEN q <br /> u <br /> i t3 ° ~ ��1 ev, <br /> EH 22 013 (Rev. 02/90) <br />